Document Detail


Are intracostal sutures better than pericostal sutures for closing a thoracotomy?
MedLine Citation:
PMID:  22431654     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A best evidence topic was written according to a structured protocol. The question addressed was to identify which thoracotomy closure method lends itself to the least postoperative pain. Altogether 109 papers were found using the reported search; of which, seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the closure by intracostal sutures with intercostal nerve sparing offers a superior postoperative pain profile for thoracotomy patients when compared with conventional techniques. Up to 1-year follow-up has shown that this technique (avoiding strangulation of the intercostal nerve) leads to lower postoperative pain and analgesic use, better ambulation and a quicker return to daily activities. Three papers (including two randomized trials) found intracostal sutures with intercostal nerve sparing techniques to be superior to conventional methods such as pericostal suture closure. Rib approximation with intercostal nerve sparing was found to be superior to rib approximation without nerve sparing in one study. Two studies associated with the creation of an intercostal muscle flap prior to the insertion of a rib retractor to be associated with significantly reduced postoperative pain. One study described a novel 'edge-closure' technique, comparable to the closure with intracostal sutures without drilling, to be superior to conventional closure with pericostal sutures. Postoperative pain is a significant issue faced by thoracic surgeons both in-hospital and in the longer term where patients may complain of chronic thoracotomy pain. We would therefore recommend that some form of intercostal nerve protection be implemented during thoracotomy opening and closure.
Authors:
Ravindran Visagan; David J McCormack; Alex R Shipolini; Omar A Jarral
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Publication Detail:
Type:  Journal Article; Review     Date:  2012-03-19
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  14     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-09-07     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  807-15     Citation Subset:  IM    
Affiliation:
King's College London School of Medicine, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Analgesics / therapeutic use
Benchmarking
Evidence-Based Medicine
Humans
Intercostal Nerves / injuries*
Neuralgia / diagnosis,  etiology,  prevention & control*
Pain Measurement
Pain, Postoperative / diagnosis,  etiology,  prevention & control*
Peripheral Nerve Injuries / diagnosis,  etiology,  prevention & control*
Surgical Flaps* / adverse effects
Suture Techniques* / adverse effects
Thoracotomy* / adverse effects
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Analgesics
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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