Document Detail


A prospective, single-blind randomised study on the effect of intercostal nerve protection on early post-thoracotomy pain relief.
MedLine Citation:
PMID:  19954996     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Intracostal suture or intercostal muscle flap can reduce post-thoracotomy pain through the preservation of intercostal nerves below or above the incision. This study aims to test whether combining intracostal suture with intercostal muscle flap might achieve better pain relief than intracostal suture alone.
METHODS: This study included 144 consecutive patients who underwent pulmonary resection. Eighty patients entered the trial but eight were excluded. Seventy-two patients were randomly assigned to a muscle flap group, in which the fifth intercostal muscle and neurovascular bundle were raised and intracostal suture on the sixth rib was applied. For the control group, only intracostal suturing on the sixth rib was done. All patients had a functional epidural placed, which were removed 24h after surgery. Differences on average numeric rating scale (aNRS) scores were assessed in an early post-operative period from day 1 to day 7 and a later period from week 2 to week 12, when patients were resting or coughing. The doses of oxycodone demand and hyperalgesia-related intercostal dermatomes (HIDs) were recorded for analysis.
RESULTS: No differences were noted between the two groups in terms of length and width of the incision, or duration of rib retraction. Neither in different time periods (early or late) nor the activity status (while resting or coughing) yielded a statistical difference on aNRS scores between the muscle flap group and the control group (muscle flap group vs control group: mean (95% confidence intervals) from d ay 1 to day 7, 4.42 (1.56-7.28) vs 4.79 (2.03-7.55) on coughing (p=0.282); median (inter-quartile range, IQR) from day 1 to day 7, 1.71 (0.86-3) vs 2.50 (1.16-3.12) while resting (p=0.279); median (IQR) from week 2 to week 12, 0.43 (0-0.86) vs 0.48 (0.06-1.20) on coughing (p=0.595); median (IQR) from week 2 to week 12, 0 (0-0.14) vs 0.05 (0-0.14) while resting (p=0.856)). No differences were found in total oxycodone consumption from day 1 to day 7 between the two groups (Z=-1.821, p=0.069). The rate of HIDs in each intercostal space and median number of HIDs were similar between the two groups on day 1 (p>0.05) and day 7 (p>0.05).
CONCLUSIONS: The combination of intracostal suture with intercostal muscle flap may not necessarily achieve better post-thoracotomy pain control than using intracostal suture alone.
Authors:
Nan Wu; Shi Yan; Xiaofei Wang; Chao Lv; Jia Wang; Qingfeng Zheng; Yuan Feng; Yue Yang
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2009-12-01
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  37     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-23     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  840-5     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital & Institute, No. 52, Fucheng Avenue, Haidian District, Beijing 100142, PR China.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analgesics, Opioid / administration & dosage
Drug Administration Schedule
Female
Humans
Intercostal Muscles / transplantation
Intercostal Nerves / injuries*
Lung Neoplasms / surgery*
Male
Middle Aged
Oxycodone / administration & dosage
Pain Measurement / methods
Pain, Postoperative / etiology,  prevention & control*
Prospective Studies
Single-Blind Method
Surgical Flaps
Sutures
Thoracotomy / adverse effects,  methods*
Chemical
Reg. No./Substance:
0/Analgesics, Opioid; 76-42-6/Oxycodone

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


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