Abstract
Objective:To assess the efficacy of intercostal nerve protection by intercostal muscle (ICM) flap in post-thoracotomy pain improvement compared to intracostal suturing.Methods:In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2nd week, 1st, 2nd, 4th and 6th months after thoracotomy.Results:Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 ± 17.6 years, it was 47.4 ± 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 ± 74.7 minutes, while it was 219.3 ± 68.8 minutes in the second (p>0.05). Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups (p>0.05). Although the trend of pain reduction was significant in each group (p<0.001), the difference was not statistically significant (p>0.001).Conclusion:Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure.
Highlights
With due attention to diverse opinions on efficacy of intercostal muscle flap for intercostal nerve preservation compared to intracostal suture only, the current study was designed to compare the intensity of post-operative pain in asymptomatic patients that underwent posterolateral thoracotomy with and without intercostal muscle flap
After obtaining informed consent all patients admitted for posterolateral thoracotomy in cardiothoracic department of Tabriz Imam Reza Hospital from March 2012 to March 2015, were enrolled for this study. (IRCT NO: 2015122216077N4) The exclusion criteria were: presence of any pain before surgery, long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) or analgesics, narcotic addiction, psychiatric disease, radiologic evidence of invasion to parietal pleura or rib, age lower than 19, history of receiving corticosteroid in last six months, preoperative chemotherapy or radiotherapy, neuropathy, previous thoracotomy, epidural catheter dysfunction, incision infection or empyema, loss of consciousness after surgery or need for mechanical ventilation after surgery, re-operation due to hemorrhage or other thoracic emergencies and patients discharging with chest tube or Heimlich valve
Results of the current randomized controlled trial revealed that muscle flap preparation was not significantly effective in post thoracotomy pain improvement, and post-operative pain in intracostal thoracotomy closure was similar to combination of intracostal and intercostal muscle (ICM) flap technique
Summary
Chronic pain after thoracotomy is still causing significant problems influencing postoperative life quality of patients. With due attention to diverse opinions on efficacy of intercostal muscle flap for intercostal nerve preservation compared to intracostal suture only, the current study was designed to compare the intensity of post-operative pain in asymptomatic patients that underwent posterolateral thoracotomy with and without intercostal muscle flap
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