Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain

Sapkota, Ranjan; Shrestha, Upendra Thapa; Sayami, Prakash

doi:10.1177/0218492313515498

Cited by 9 publications

(6 citation statements)

References 14 publications

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“…Many anesthetic and pharmacological agents are used to decrease postthoracotomy pain. However, these drugs carry risks of side effects and control the postthoracotomy pain effectively [ 18 ]. Furthermore, a literature search suggests that acupuncture analgesia is more efficient in surgical patients when administered postoperatively [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

Chen

Wang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.

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Section: Discussionmentioning

confidence: 99%

Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

Chen

Wang

et al. 2016

Evidence-Based Complementary and Alternative Medicine

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“…Surgical techniques that protect the nerve bundle may mitigate acute pain, 1,49–58 persistent postoperative pain, 49,52–60 and analgesic consumption 49,56,59 as well as facilitate an earlier return to baseline activities 50,54,58,60 (Category A2 evidence1,49–52,54, 58,60 and Category B2 evidence 53,55,56 , 57,59 ). These include nerve-sparing thoracotomy incision, 1,59 closure with rib approximation, 51 intercostal muscle flap, 58,60 or no-compression suture techniques alone 52,53,56 or in combination 49–51,54,55,57 to avoid intercostal nerve compression or involvement. 1,49–60 However, some studies 61–63 showed that surgical technique has no influence on the incidence of acute or persistent postoperative pain after surgery (Category A2 evidence).…”

Section: Preoperative Evaluation Of Risk Factors For Pain and Opioid ...mentioning

confidence: 99%

“…These include nerve-sparing thoracotomy incision, 1,59 closure with rib approximation, 51 intercostal muscle flap, 58,60 or no-compression suture techniques alone 52,53,56 or in combination [49][50][51]54,55,57 to avoid intercostal nerve compression or involvement. 1,[49][50][51][52][53][54][55][56][57][58][59][60] However, some studies [61][62][63] showed that surgical technique has no influence on the incidence of acute or persistent postoperative pain after surgery (Category A2 evidence).…”

Section: Surgical Factors That Influence Acute And/ormentioning

confidence: 99%

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Makkad

Heinke

Sheriffdeen

et al. 2023

Anesthesia &Amp; Analgesia

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Pain after thoracic surgery is of moderate-to-severe intensity and can cause increased postoperative distress and affect functional recovery. Opioids have been central agents in treating pain after thoracic surgery for decades. The use of multimodal analgesic strategies can promote effective postoperative pain control and help mitigate opioid exposure, thus preventing the risk of developing persistent postoperative pain. This practice advisory is part of a series developed by the Society of Cardiovascular Anesthesiologists (SCA) Quality, Safety, and Leadership (QSL) Committee’s Opioid Working Group. It is a systematic review of existing literature for various interventions related to the preoperative and intraoperative pain management of thoracic surgical patients and provides recommendations for providers caring for patients undergoing thoracic surgery. This entails developing customized pain management strategies for patients, which include preoperative patient evaluation, pain management, and opioid use–focused education as well as perioperative use of multimodal analgesics and regional techniques for various thoracic surgical procedures. The literature related to this field is emerging and will hopefully provide more information on ways to improve clinically relevant patient outcomes and promote recovery in the future.

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“…This conclusion is supported by the work published by Sapkota and colleagues. 1 However, the completion of an intercostal flap for applying a separator combined with an intracostal suture provides no improvement in the control of acute or subacute pain regarding the intracostal suture technique without an intercostal flap (level of evidence grade A).…”

mentioning

confidence: 99%

“…We read with great interest the article by Sapkota and colleagues. 1 Their study, a randomized clinical trial, included 48 patients over a period of 15 months. Twenty-five patients were included in a control group, and underwent pericostal suture of intercostal space by the classic technique; 23 patients formed the study group, with suture of the intercostal space by an intracostal technique.…”

mentioning

confidence: 99%

Intercostal muscle flap and intracostal suture: is two better than one?

García-Tirado

Landa-Oviedo

Rieger-Reyes³

2014

Asian Cardiovasc Thorac Ann

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We read with great interest the article by Sapkota and colleagues. 1 Their study, a randomized clinical trial, included 48 patients over a period of 15 months. Twenty-five patients were included in a control group, and underwent pericostal suture of intercostal space by the classic technique; 23 patients formed the study group, with suture of the intercostal space by an intracostal technique. Also, a flap of intercostal muscle at the start of the operation was performed only in the study group. Therefore, in the study group two combined techniques were used for reducing post-thoracotomy pain. Both techniques and their effectiveness have been described by Cerfolio and colleagues, 2,3 as reflected in the article by Sapkota. Since then, several studies have examined their role in the control of acute and chronic post-thoracotomy pain. In a systematic review published by our group, 4 we analyzed the evidence so far, and we concluded that the combination of an intercostal flap to prevent nerve compression by the rib spreader, with an intracostal suture technique, is significantly more effective in the control of immediate and long-term pain, compared to the classic pericostal suture (level of evidence grade A). This conclusion is supported by the work published by Sapkota and colleagues. 1 However, the completion of an intercostal flap for applying a separator combined with an intracostal suture provides no improvement in the control of acute or subacute pain regarding the intracostal suture technique without an intercostal flap (level of evidence grade A).Based on the available evidence, we ask if two is better than one? In any case, it seems to us to be a job very well done, with results and conclusions consistent and concordant with published evidence. With this contribution, the importance of the techniques for protection of intercostal nerves in preventing post-thoracotomy pain is strengthened.

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Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain

Abstract: these techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.

Cited by 9 publications

References 14 publications

Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

Practice Advisory for Preoperative and Intraoperative Pain Management of Thoracic Surgical Patients: Part 1

Intercostal muscle flap and intracostal suture: is two better than one?

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