Objective: The aims of this study were to evaluate serum levels of acute phase reactants, such as CRP and cytokines (TNF-α and IL-6) in patients who have undergone thoracotomy and to investigate the effects of flurbiprofen on postoperative inflammatory response.Methods: Forty patients undergoing posterolateral thoracotomy were randomly divided into 2 groups of 20 each. Control group received tramadol (4 x 100 mg) intravenously for four days, and flurbiprofen group received both tramadol (4 x 100 mg) and flurbiprofen (2 x 100 mg). Blood samples were collected before surgery and at the 3th and 168th hours after surgical procedure to measure serum CRP, IL-6, and TNF-α. Pain visual analog scales were recorded daily during the first four postoperative days. Spirometric measurement of forced expiratory volume in the first second (FEV 1) was done before and four days after the operation.Results: The serum CRP, IL-6, and TNF-α levels in both groups increased significantly at 3th hour after thoracotomy. Serum TNF-α levels did not differ significantly between the groups at postoperative 4th day. However, IL-6 and CRP were significantly lower in flurbiprofen group than in control group at the same day (p<0.05). Visual analog scale was significantly lower in flurbiprofen group at 6th, 12th, 48th, 72th, and 96th hours postoperatively (p<0.05). The patients receiving flurbiprofen had higher FEV 1 values when compared with control group at postoperative 4th day.Conclusions: Patients undergoing thoracotomy showed reduced postoperative pain, mean additional analgesic consumption, and serum IL-6 and CRP levels, when flurbiprofen was added to systemic analgesic therapy. Analgesia with anti-inflammatory drug may contribute to the attenuation of the postoperative inflammatory response and prevent postoperative pain in patients undergoing thoracotomy.

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The patients undergoing lung resection through a thoracotomy were observed with reduced postoperative pain and better surgical outcomes with respect to the length of hospital stay, postoperative forced expiratory volume in the first second, pulmonary complications, and need for bronchoscopic management, when paravertebral subpleural analgesia was induced by morphine.

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This study sought to investigate the effect of the needle maneuver count and number of pleural punctures on pneumothorax in CT-guided transthoracic core needle biopsy. Material and Method: Records of CT-guided core needle biopsy performed on patients were retrospectively reviewed. Demographic data, procedure reports, pathology reports, tomography images, follow-up examinations, and complications due to biopsy were examined. Next, the number of times the needle penetrated the pleura and the number of maneuvers in the lung were listed. The number of pleural punctures was recorded either as 1 or ≥2. The needle maneuver count was recorded either as 1, 2, or ≥3. All listed variables were statistically evaluated. Results: A total of 393 patients were included in the study. Complications of pneumothorax occurred in 87 (22.1%) patients. A thorax tube application due to pneumothorax was required in 39 (9.9%) patients. When the needle maneuver count in the lungs during biopsy was greater than 3, the incidence of pneumothorax and the need for a thorax tube application were increased (p=0.001). As the size of the lesion decreased and the lesion-pleura distance increased, the needle maneuver count in the lung increased (p=0.001, p=0.008). Pneumothorax and thorax tube application rates were increased in 48 patients with pleural punctures ≥2 (p=0.001, p=0.001). Conclusion:In CT-guided pulmonary transthoracic core needle biopsy applications, needle maneuver count and the number of pleural punctures constitute the major factors contributing to the risk of developing pneumothorax.

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