Abstract
Background and Objectives: Chronic post-thoracotomy pain syndrome (PTPS) is a very common and uncomfortable complication, occurring frequently after thoracic operations, leading to the necessity of further medication and hospitalizations. One important risk factor in developing chronic pain is the chest closure technique, which can lead to chronic intercostal nerve damage. This study proposes an alternative nerve-sparring closure technique to standard peri-costal sutures, aimed toward minimizing the risk of chronic pain in selected patients. Materials and Methods: We performed a prospective randomized study on 311 patients operated for various thoracic pathology over a period of 12 months, evaluating incision types, chest closure technique, and number of drains with drainage duration. The patients were divided into three groups: peri-costal (PC), proposed extra-costal (EC), and simple (SC) suture, respectively. Pain was measured on day 1, 2, 5, 7, and at 6 months post-operatively using the Visual Analogic Scale. Results: No significant differences in pain level were recorded in the first two post-operative days between the PC and EC groups. However, a significant decrease in pain level was observed on day 5 and at 6 months post-operatively, with a mean level of 3.5 ± 1.8, 1.2 ± 1 for the EC group compared to a mean value of 5.3 ± 1.6, 3.2 ± 1.5, respectively. No significant differences were observed regarding other evaluated variables. Conclusions: The lower recorded pain scores in patients with extra-costal chest closure are a strong argument to use this technique. Its ease of use is similar to the classic peri-costal closure, and the time needed to perform it is not significantly increased. The association of this technique with less invasive procedures and short drainage duration limits chronic post-operative pain. This procedure may represent an option for decreasing healthcare costs associated with the management of PTPS.
Highlights
A surgeon has to deal over the course of his career with the specific pathology of his patients, and with the management of pain
This paper describes an alternative thoracotomy closure technique intended to minimize chronic post-operative pain by minimizing pressure on the intercostal nerve, suited to close the chest in selected cases
Statistically significant differences were recorded for the whole study group for the procedure length and mean number of chest drains, post hoc analysis revealed that no significant differences were present between PC and EC groups
Summary
A surgeon has to deal over the course of his career with the specific pathology of his patients, and with the management of pain. Thoracic incisions are known to be amongst the most painful surgical approaches, generating acute post-operative pain, and chronic pain, with frequencies varying between 40% and 60% [1,2,3]. This leads to a poor quality of life for thoracic surgery patients, and in some cases many patients require a further surgical procedure—intercostal neurectomy to attenuate the pain. Materials and Methods: We performed a prospective randomized study on 311 patients operated for various thoracic pathology over a period of 12 months, evaluating incision types, chest closure technique, and number of drains with drainage duration. Results: No significant differences in pain level were recorded in the first two post-operative days between the PC and EC groups
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