Thoracotomy Pain Syndrome Research Articles

Nerve changes associated with post thoracotomy pain syndrome.

Chronic post-thoracotomy pain (PTPS) is a frequent complication of thoracic operations. Sometimes the pain is excruciating enough to impair activities of daily living (ADL). All thoracic procedures have the potential to cause trauma to the intercostal nerves due to retractor use, chest closure techniques, and or wound healing. In our study, we analyzed the microscopic aspects of the nerves involved in the healing process, to better understand the histopathology of chronic pain. 29 patients with PTPS underwent intercostal neurectomy to alleviate the symptoms. Microscopic specimens harvested during the surgeries were sent to our pathology unit for evaluation. The following data regarding the surgical procedures was collected: surgical approach, chest closure type, number of excised nerves, and time interval from previous surgery to neurectomy. A mean of 2.34±1.11 nerves were excised. Microscopy of the specimens revealed: fibrosis, hyalinization of the epineurium and perineurium, intense hyperemia of the blood capillaries, and interstitial edema. 7 cases presented with myxoid degeneration of epineurium and perineurium. In all the cases, endoneurium, myelin sheaths, and axons were interrupted. The endoneurium showed the presence of hyperemic dilated capillaries. The segmental cytoplasmic vacuolization of Schwann's cells with the total disappearance of axons was also noted. 60% of the examined specimens had intraneural myxoid degeneration, with highly dense irregular connective tissue around nerve fibers. The pathologic findings in the structure of the intercostal nerves obtained from the patients are indicative of the involvement of the wound healing mechanisms in PTPS. The negative impact of wound healing could be considered a key component in the development of intense chronic pain.

Pregabalin versus Pulsed Radiofrequency of Dorsal Root Ganglion for Treatment of Chronic Post Thoracotomy Pain Syndrome

Pregabalin versus Pulsed Radiofrequency of Dorsal Root Ganglion for Treatment of Chronic Post Thoracotomy Pain Syndrome

Serratus Anterior Plane Block as a Regional Analgesia Technique for Post Thoracotomy and Thoracoscopy Pain: Review Article

Background: Chest wall surgeries are accompanied by severe postoperative pain. Inadequate relief of this pain may lead to both pulmonary complications as lung atelectasis and infection and chronic post thoracotomy pain syndrome. Regional analgesic modalities are important portion of the multimodal therapeutic approach suggested for the management of post thoracotomy pain. Objective: To evaluate serratus anterior plane block as a regional analgesia technique for post thoracotomy and thoracoscopy pain. Recent Findings: Serratus anterior plane block (SAPB), a regional analgesic modality developed by Blanco et al. in 2013, has shown good analgesic effect after thoracotomy and thoracoscopy in many case reports and clinical trials. In such block, a local anesthetic is injected in the fascial plane deep or superficial to the serratus anterior muscle leading to block of lateral cutaneous branches of the intercostal nerves. This provides a sensory block of T2–T9 dermatomes. Conclusion:Serratus anterior plane block as a fascial plane block can be a preferred regional analgesia technique for both post-operative pain management with procedures involving anterolateral chest wall as thoracotomy, thoracoscopy and breast surgery and in cases of multiple rib fractures. This is owing to its easy technique, effective pain relief and potentially better side effects profile compared to other regional modalities and systemic opioids.

Post-Thoracotomy Pain: Review Article

Background: Thoracotomy is a very painful surgical procedure that is used to get access into the pleural space, to the lungs, to the heart, to the esophagus or to get access to the thoracic aorta or anterior mediastinum. Objective: To study different modalities of treatment used for post thoracotomy pain control. Recent Findings: Inadequate post-thoracotomy analgesia enhances the postoperative stress response with deleterious effects on respiratory, cardiovascular, gastrointestinal, urinary, immune and coagulation systems. In addition to anxiety and increased risk of Post Thoracotomy Pain Syndrome (PTPS), which can interfere with normal life and may persist for years or even for life? Conclusion: Providing adequate post-thoracotomy analgesia can be challenging, as patients are often elderly or having multiple comorbidities. A multimodal approach is considered in managing post-thoracotomy pain starting with preemptive analgesia and cognitive behavioral modalities in addition to conventional multimodal systemic regimens as opioids, acetaminophen, NSAID, cyclooxygenase (COX)-2-specific inhibitors, gabapentin and pregabalin, steroids, IV lidocaine infusion, ketamine, and many regional analgesic modalities to avoid or decrease adverse effects of systemic regimens. These regional analgesic modalities include thoracic epidural blocks, thoracic paravertebral blocks, intrathecal opioid analgesia, serratus anterior plane blocks, intercostal nerve blocks, interscalene block, erector spinae block and interpleural block.

Perioperative analgesia for the prolepsis of persistence of post-thoracotomy chronic neuropathic pain

Abstract: Proper perioperative analgesic management of Thoracic surgery cases constitutes a primary factor for the successful outcome of the surgery, having created the ideal conditions for both the thoracic surgeon and the anesthesiologist, but mainly for the avoidance of postoperative pain for the patient. 5%-67% of thoracic surgery cases reports post thoracotomy pain syndrome that can persist for up to 20 years. Purpose: To give prominence to the benefits of analgesics for the patient undergoing thoracic surgery after having received appropriate perioperative treatment and starts analgesic protection from the time preceding surgical incision to the patient’s complete recovery, as far as prevention of chronic neuropathic pain is concerned. Complete analgesic protection presupposes the interdisciplinary collaboration of the surgeon and the anesthesiologist with the patient. Materials & methods: Thorough review of scientific literature in scientific databases (PubMed, Scopus, SignaVitae) concerning perioperative analgesia in thoracotomies. Results: In our effort to prevent the persistence of Chronic Neuropathic Pain, we always take into consideration the fact that thoracotomy patients suffer from respiratory complications/uneasy breathing with invasive analgesia techniques. Therefore, we remain alert to reduce the use of opioids and their adverse effects on those patients. Major analgesic outcomes and avoidance of persistence of chronic neuropathic pain can be achieved with the following procedure: (1) Intravenous administration of non-steroidal anti-inflammatories, paracetamol, dexamethasone 8 mg, NMDA receptor antagonist (Ketamine 30 mg) before incision as well as local infusion of Ropivacaine 2% solution. (2) Intravenous infusion of lidocaine, fentanyl, remifentanil, morphine, tramadol, Mg, ketamine, during surgery by adjusting doses per patient and operative time. (3) Particular caution is suggested in the immediate postoperative period so as to avoid transition from acute postoperative pain to chronic neuropathic pain. Our armamentarium includes paracetamol, tramadol, dexketoprofen, oxycodone per os, PCA morphine, pain busters (paired drainage catheters with elastomeric pumps) of ropivacaine 2%, patch lidocaine and thoracic epidural analgesia with ropivacaine pumps and intercostal block nerve conduction. A medical record of the postoperative analgesic course of our patients is kept and completed by our medical and nursing staff. Conclusions: Perioperative analgesia is our key concern in all thoracic surgeries, so as to prevent post thoracotomy pain syndrome. For the purpose of this concern, we administer analgesic treatment on all surgery stages as well as keep postoperative analgesic record.

P93 BELSEY MARK IV: STILL A VALID OPTION. SINGLE CENTER EXPERIENCE OF 100 CONSECUTIVE CASES

Abstract Aim To share the single-center experience of a tertiary referral center using the Belsey Mark IV operation in the treatment of large primary hiatal hernias (PHH) and recurrent hernias after failed antireflux surgery. Background & Methods We conducted a retrospective analysis of all patients with PHH or recurrent hernia after antireflux surgery operated between May 1, 2012 and December 31, 2016 who received a Belsey-Mark IV antireflux procedure. Data on patient demographics, surgical history, pre-operative work-up, indication, short- and long-term complications graded by the Clavien-Dindo classification (CDC) and recurrence rate, defined as clinical symptoms confirmed with barium swallow test, were collected and analyzed. Results A total of 100 consecutive cases were included in this analysis. Median age at time of surgery was 67 years (range 0 - 86). Seventy-two were female. Indications were: PHH Type I (n = 2), Type II (n = 1); Type III (n = 55), Type IV (n = 3), redo after previous antireflux surgery (n = 39). Median follow-up was 23 months (range 4-80). Major peri-operative short-term morbidity (defined as CDC 3-4) was present in 14 cases, with respiratory complications being the most prevalent. Fundoplication leakage was present in five cases and managed conservatively in three of those. Hernia recurrence rate was 31% in the redo group (12/39) and 10% in the PHH group (6/61). Median time-to-recurrence was 22 months (range 2-78). Post thoracotomy pain syndrome requiring treatment (CDC 2) was present in 12 cases. One patient deceased due to respiratory complications after emergency Belsey Mark IV repair following early recurrence after laparoscopic Nissen fundoplication and two reinterventions. Conclusion The Belsey Mark IV repair is a safe and effective procedure in experienced hands, with well-defined risks and an acceptable recurrence rate, given the nature of the condition and patient’s comorbidities.

A French version of Ringsted's questionnaire on pain-related impairment of daily activities after lung surgery: A cohort study

BackgroundThe questionnaire from Ringsted et al. (RQ) assesses the consequences on daily activities of a post–thoracotomy pain syndrome. Our study aimed at translating the RQ into French and to validate its metrological properties. MethodsFour months after thoracotomy, 134 patients participating in a prospective comparative study of two surgical thoracotomy approaches (axillary and posterolateral) scored the translated questionnaire. The sensitivity of this version was assessed by comparing scores from patients complaining of pain to that of non-complainers. Concurrent validity was assessed using ratings from direct questions on pain, mood, anxiety and enjoyment of life. Homogeneity was assessed with Crombach's coefficient and dimensionality with PCA. ResultsA scoring system was devised to homogenise pain-related impairment with activities that were never performed before surgery and activities that had to be abandoned due to pain. The French version is bi-dimensional: routine activities (carrying heavy loads, raising the arms above the head, housework, getting out of bed, car driving, lying on the operated side, coughing, sitting for half an hour) are opposed to running, walking 1 km, climbing stairs, bending knees, standing for half an hour, swimming and cycling; both these factors contribute independently to the global score. Global and factor scores are sensitive to presence of pain while direct questions account for 20 to 50 % of the information provided by the questionnaire. ConclusionThe French version of the RQ is suitable to assess chronic repercussions of lung surgery on the ability of patients to perform their daily activities.

Post – operative analgesia in patients under thoracotomy

The thoracotomy is one of the most painful surgery operations, and the final outcome is directly associated with the postoperative pain control, because it allows quick mobilization, intense respiratory physiotherapy and reduces postoperative morbidity. Unfortunately, patients under thoracotomy, incur a significant risk of chronic pain. Although there are guidelines for the management of post-operative pain relief in these patients, however there is no widespread surgical or anesthetic "gold standard." In the present article it has been investigated the current literature related to the proposed therapies and other interventions that were recommended for post-operative pain relief after thoracotomy. The treatment of chronic pain after thoracotomy is difficult and includes physical rehabilitation techniques and multimodal approach. More and more researchers support that minimization of acute post-operative pain is the best method so as to avoid, prevent or reduce post- thoracotomy pain syndrome.

Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series

Background and aimsPost thoracotomy pain syndrome (PTPS) remains a common complication of thoracic surgery with significant impact on patients’ quality of life. Management usually involves a multidisciplinary approach that includes oral and topical analgesics, performing appropriate interventional techniques, and coordinating additional care such as physiotherapy, psychotherapy and rehabilitation. A variety of interventional procedures have been described to treat PTPS that is inadequately managed with systemic or topical analgesics. Most of these procedures are technically complex and are associated with risks and complications due to the proximity of the targets to neuraxial structures and pleura. The ultrasound-guided erector spinae plane (ESP) block is a novel technique for thoracic analgesia that promises to be a relatively simple and safe alternative to more complex and invasive techniques of neural blockade. We have explored the application of the ESP block in the management of PTPS and report our preliminary experience to illustrate its therapeutic potential. MethodsThe ESP block was performed in a pain clinic setting in a cohort of 7 patients with PTPS following thoracic surgery with lobectomy or pneumonectomy for lung cancer. The blocks were performed with ultrasound guidance by injecting 20–30mL of ropivacaine, with or without steroid, into a fascial plane between the deep surface of erector spinae muscle and the transverse processes of the thoracic vertebrae. This paraspinal tissue plane is distant from the pleura and the neuraxis, thus minimizing the risk of complications associated with injury to these structures. The patients were followed up by telephone one week after each block and reviewed in the clinic 4–6 weeks later to evaluate the analgesic response as well as the need for further injections and modification to the overall analgesic plan. ResultsAll the patients had excellent immediate pain relief following each ESP block, and 4 out of the 7 patients experienced prolonged analgesic benefit lasting 2 weeks or more. The ESP blocks were combined with optimization of multimodal analgesia, resulting in significant improvement in the pain experience in all patients. No complications related to the blocks were seen. ConclusionThe results observed in this case series indicate that the ESP block may be a valuable therapeutic option in the management of PTPS. Its immediate analgesic efficacy provides patients with temporary symptomatic relief while other aspects of chronic pain management are optimized, and it may also often confer prolonged analgesia. ImplicationsThe relative simplicity and safety of the ESP block offer advantages over other interventional procedures for thoracic pain; there are few contraindications, the risk of serious complications (apart from local anesthetic systemic toxicity) is minimal, and it can be performed in an outpatient clinic setting. This, combined with the immediate and profound analgesia that follows the block, makes it an attractive option in the management of intractable chronic thoracic pain. The ESP block may also be applied to management of acute pain management following thoracotomy or thoracic trauma (e.g. rib fractures), with similar analgesic benefits expected. Further studies to validate our observations are warranted.

Perioperative Ketamine Administration for Thoracotomy Pain

Background: Of all the postsurgical pain conditions, thoracotomy pain poses a particular therapeutic challenge in terms of its prevalence, severity, and ensuing postoperative morbidity. Multiple pain generators contribute to the severity of post-thoracotomy pain, and therefore a multimodal analgesic therapy is considered to be a necessary strategy. Along with opioids, thoracic epidural analgesia, and paravertebral blocks, N-Methyl-D-Aspartate (NMDA) receptor antagonists such as ketamine have been used as adjuvants to improve analgesia. Objective: We reviewed the evidence for the efficacy of intravenous and epidural administration of ketamine in acute post-thoracotomy pain management, and its effectiveness in reducing chronic postthoracotomy pain. Study Design: Systematic literature review and an analytic study of a data subset were performed. Methods: We searched PubMed, Embase, and Cochrane reviews using the key terms “ketamine,” “neuropathic pain,” “postoperative,” and “post-thoracotomy pain syndrome.” The search was limited to human trials and included all studies published before January 2015. Data from animal studies, abstracts, and letters were excluded. All studies not available in the English language were excluded. The manuscript bibliographies were reviewed for additional related articles. We included randomized controlled trials and retrospective studies, while excluding individual case reports. Results: This systematic literature search yielded 15 randomized control trials evaluating the efficacy of ketamine in the treatment of acute post-thoracotomy pain; fewer studies assessed its effect on attenuating chronic post-thoracotomy pain. The majority of reviewed studies demonstrated that ketamine has efficacy in reduction of acute pain, but the evidence is limited on the long-term benefits of ketamine to prevent post-thoracotomy pain syndrome, regardless of the route of administration. A nested analytical study found there is a statistically significant reduction in acute post-thoracotomy pain with IV or epidural ketamine. However currently, the evidence for a role of ketamine as a preventative agent for chronic postthoracotomy pain is insufficient due to the heterogeneity of the studies reviewed with regard to the route of administration, dosage, and outcome measures. Limitations: The evidence for a role of ketamine as a preventative agent for chronic post-thoracotomy pain is insufficient due to the heterogeneity of the studies reviewed. Conclusion: The majority of randomized controlled trials reviewed show no role for ketamine in attenuating or preventing post-thoracotomy pain syndrome at variable follow-up lengths. Therefore, additional research is warranted with consideration of risk factors and long-term follow-up for chronic post-thoracotomy pain though the evidence for benefit appears clear for acute post-thoracotomy pain. Key words: Ketamine, postoperative, thoracotomy pain, post thoracotomy pain syndrome, neuropathic pain

A retrospective study of open thoracotomies versus thoracoscopic surgeries for persistent postthoracotomy pain

ObjectivePersistent thoracotomy pain syndrome (PTPS) is a recognized complication and is considered to be less after video-assisted thoracoscopic surgery (VATS) compared with open thoracic surgery (OTS). The primary objective was to compare the incidence of PTPS at 6 months. Secondary objectives were to compare the incidence of neuropathic pain between VATS and OTS and to report perioperative factors associated with the development of PTPS. MethodsThis historical cohort study involved patient contact by a questionnaire regarding the presence of PTPS and its type. Patient, surgical, and analgesia factors were collected from health records, acute pain, and thoracic surgery databases. The data were analyzed using a multivariable logistic regression analysis, with results reported as adjusted odds ratio (OR) (95% confidence interval; P value). ResultsOf 308 patients, 130 returned their questionnaire, and 106 responses were analyzed. The incidence of PTPS was 35% and 54% with VATS and OTS respectively, with an adjusted OR, 0.33 (95% confidence interval, 0.13-0.86), P= .024. The percentage of neuropathic pain was 18% and 48%, with VATS and OTS respectively, with an adjusted OR, 0.18 (0.04-0.85), P= .031. The diagnosis of cancer and previous chronic pain history were observed to be significantly associated with PTPS. ConclusionsOur study indicates that PTPS is significantly more common and has a higher chance of being neuropathic with OTS. Despite being relatively less traumatic, VATS still carries a significant potential for PTPS. A diagnosis of cancer and history of previous pain are highly predictive of its development.

Impact of intercostal paravertebral neurectomy on post thoracotomy pain syndrome after thoracotomy in lung cancer patients: a randomized controlled trial.

Thoracotomy leads to chronic neuropathic pain in up to 50% of patients and is responsible for an impaired quality of life. Intercostal nerve injury has been suggested to be responsible for this pain. In the present study the impact of paravertebral intercostal neurectomy on post thoracotomy pain was assessed. In this single center parallel-group randomized controlled trial patients underwent muscle sparing anterolateral thoracotomy and anatomical lung resection for lung cancer. A subcostal approach was used for thoracotomy with single paravertebral neurectomy being performed at the beginning of the procedure at the level of the retracted intercostal space. For documentation of neuropathic pain the Leeds Assessment Score for Neuropathic Symptoms and Signs (LANSS) was used postoperatively. The primary endpoint was defined as LANSS ≥12 points on day 120. In addition, the numeric pain rating scale (NRS) was used to score pain intensity. Out of 172 patients initially randomized 161 patients were investigated following intraoperative and postoperative drop-out criteria. All patients required anatomical lung resection via thoracotomy. Five patients were lost for follow up. For the remaining 156 patients there was no difference between the two groups with regard to LANSS ≥12: 26.6% in patients with neurectomy and 28.8% in control-subjects (P=0.78). In addition, the NSR score at day 120 did not differ significantly at rest and during activity between the two groups (at rest: 21.7% vs. 15.8% P=0.439; activity: 24.5% vs. 21.9% P=0.735). Neurectomy was not shown to reduce the post thoracotomy pain syndrome in patients with anatomical lung resection following anterolateral muscle sparing thoracotomy.

Effect of paravertebral dexmedetomidine administration on intraoperative anaesthetic drug requirement and incidence of post thoracotomy pain syndrome

Effect of paravertebral dexmedetomidine administration on intraoperative anaesthetic drug requirement and incidence of post thoracotomy pain syndrome

Surgical Strategy and Treatment for the Prevalence of the Post- Thoracotomy Pain Syndrome

The various types of pain evoked after thoracic surgery are wound pain, pulmonary apex pain due to the drain, pain caused by intercostal nerve damage, visceral pain due to manipulation of the pleura/bronchi during surgery. As the dominant nerve differs among painful areas, the innervation regions requiring analgesia are extensive, causing difficulty in pain control. These pains are treated by the thoracic epidural anesthesia, the administration of anti-inflammatory analgesics such as non- steroidal anti-inflammatory drugs, gabapentin (anti-epileptic drug) as a central nerve system drug, or tranquilizers.

A Systematic Evaluation of Thoracic Interlaminar Epidural Injections

Background: There is a paucity of literature on the use of epidural injections for the treatment of chronic mid and upper back pain due to disc herniation and radiculitis, axial or discogenic pain, spinal stenosis, post surgery syndrome, and post thoracotomy pain syndrome. Study Design: A systematic review of therapeutic thoracic epidural injection therapy for chronic mid and upper back pain. Objective: The objective of this systematic review is to determine the effects of thoracic interlaminar epidural injections with or without steroids, with or without fluoroscopy, and for various conditions including disc herniation and radiculitis, axial or discogenic pain, spinal stenosis, post thoracic surgery syndrome, and post thoracotomy pain syndrome. Methods: The available literature on thoracic interlaminar epidural injections with or without steroids in managing various types of chronic mid and upper back pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and the criteria developed by the Newcastle-Ottawa Scale criteria for observational studies. The level of evidence was classified as good, fair, or limited (or poor) based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to March 2012, and manual searches of the bibliographies of known primary and review articles. Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this review, 17 studies were identified, including studies examining adverse reactions. Only 2 studies were included: one randomized trial and one non-randomized or observational study. The results of this systematic review evaluating the effectiveness of thoracic epidural injections with or without steroids in managing chronic thoracic pain shows fair evidence with one randomized trial in patients with various causes; whereas the evidence is limited based on one non-randomized study evaluating chronic pain in post thoracotomy syndrome. Limitations: The limitations of this study include paucity of evidence. Conclusion: The evidence based on this systematic review for thoracic epidural injection in treating chronic thoracic pain is considered fair and limited for post thoracotomy pain. Key words: Spinal pain, chronic mid back pain, chronic upper back pain, post-thoracotomy pain, thoracic epidural injection, radiculopathy, herniation, steroids, local anesthetic, epidural steroid

Spinal Cord Stimulation for Treatment of Pain in a Patient with Post Thoracotomy Pain Syndrome

Post Thoracotomy Pain Syndrome (PTPS) is defined as pain that occurs or persists in the area of the thoracotomy incision for at least 2 months following the initial procedure. The true incidence of PTPS is hard to define as literature reports a wide range of occurrence from 5% to 90%. Thoracotomy is associated with a high risk of severe chronic postoperative pain. Presenting symptoms include both neuropathic pain in the area of the incision, as well as myofascial pain commonly in the ipsilateral scapula and shoulder. Pain management can be challenging in these patients. Multiple treatments have been described including conservative treatments with oral nonsteroidal anti-inflammatory drugs (NSAIDs); topically applied, peripherally acting drugs; neuromodulating agents; physical therapy; transcutaneous electrical nerve stimulation as well as more invasive treatments including intercostal nerve blocks, trigger point steroid injections, epidural steroid injections, radiofrequency nerve ablation, cryoablation, and one case report of spinal cord stimulation. Unfortunately, a portion of these patients will have persistent pain in spite of multiple treatment modalities, and in some cases will experience worsening of pain. This case report describes the novel utility and complete resolution of symptoms with spinal cord stimulation (SCS) in treatment of a patient with persistent PTPS. In the operating room, a percutaneous octet electrode lead was placed using sterile technique under fluoroscopic guidance and loss-of-resistance technique. The octet electrode lead was subsequently advanced with the aid of fluoroscopy to the level of the T3 superior endplate just right of midline. The patient’s pain distribution was captured optimally with stimulation at this level. With the assistance of a neurosurgeon, the lead was anchored, tunneled, and connected to a generator, which was implanted over the right iliac crest. The patient tolerated the procedure well with no complications. We report the successful use of SCS as well as complete resolution of symptoms at 4 months follow-up, in a patient with persistent PTPS, which was resistant to other modalities. In conclusion, studies designed to evaluate the effectiveness of SCS for PTPS may be warranted. Key words: post thoracotomy pain syndrome, PTPS, chronic pain, spinal cord stimulation, thoracic pain, neuropathic pain, transcranial magnetic stimulation

CT Guided Percutaneous Cryoneurolysis for Post Thoracotomy Pain Syndrome: Early Experience and Effectiveness

The aim of this study was to determine the effect of cryoablation on pain levels in patients with histories of post-thoracotomy pain syndrome. Eighteen patients were included in this retrospective review. Preprocedural and immediate postprocedural pain scores were recorded, as well as several months after the procedures. The average preprocedural pain score was 7.5 +/- 2.0, which decreased to 1.2 +/- 1.9 immediately after the procedure. After a mean follow-up period of 51 days, the average pain score was 4.1 +/- 1.7. The difference between preprocedural and postprocedural pain scores was statistically significant by Wilcoxon's rank sum test. Cryoneurolysis of the intercostal nerves statistically significantly decreased pain scores in patients with post-thoracotomy pain syndrome.

Comparing efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

Comparing efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

39: Comparing efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

39: Comparing efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

441 Comparing the efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome

441 Comparing the efficacy of thoracic transforaminal injection of magnesium versus intercostal nerve block with methylprednisolone for chronic post thoracotomy pain syndrome