Comparison of non-divided intercostal muscle flap and intercostal nerve cryoanalgesia treatments for post-oesophagectomy neuropathic pain control

Abstract

Oesophagectomy is at present considered to be the optimal curative treatment for patients with severe oesophageal disease. Postoperative pain, both acute and chronic, plays a significant role in the quality of life for post-oesophagectomy patients. The present study compared the effects of two methods-application of a non-divided intercostal muscle flap (NIMF) and intercostal nerve cryoanalgesia (INC) treatment-in reducing neuropathic pain in post-oesophagectomy patients. From June 2009 to June 2010, a total of 160 patients who underwent posterolateral thoracotomy and oesophagectomy were subsequently recruited to our study and divided into NIMF groups and INC groups at random. Patient follow-up studies were conducted for one year on all the subjects and the resultant postoperative pain, chronic pain, rehabilitation and complication scored were measured and documented. INC treatment was more time-intensive than NIMF treatment (P < 0.05). Also, additional chest tube drainage and subsequent extubation were often necessary in the INC group (P < 0.001). No statistically significant differences were found between the two groups regarding the number of subjects who required oral medication one month postoperative with respect to pain score. The chronic pain level, as well as the number of patients requiring oral pain medication, increased significantly by the sixth month following operation and notably increased until the 12th postoperative month in the INC group (P < 0.05). Both NIMF and INC treatments were effective and safe for the treatment of acute pain after oesophagectomy. NIMF was the better technique in reducing chronic postoperative pain.