Analysis of 11 Trials Comparing Muscle-Sparing with Posterolateral Thoracotomy

Li, Shikang; Feng, Zhiqiang; Wu, Liucheng; Qiangxin, Huang; Pan, Sining; Tang, Xin-Yuan; Ma, Buguo

doi:10.1055/s-0033-1337445

Cited by 25 publications

(11 citation statements)

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“…In addition when study participants continued with the exercise programme after hospital discharge it improved their quality of life. This finding of the study is of value considering that shoulder dysfunction often develops in patients following an open thoracotomy because of pain (El-Ansary et al 2016 ; Li et al 2014 ; Yamaqhuci et al 2006 ). Thus, implementing a post-operative physiotherapy treatment regime including the said modalities listed by Reeve et al ( 2010 ) and Rodriquez-Larrad et al ( 2016 ), as was done here, may influence patients’ length of hospital stay, the likelihood of patients developing PPCs and could reduce patients’ pain levels, improve their shoulder function and general quality of life.…”

Section: Discussionmentioning

confidence: 77%

“…Patients in South Africa who undergo open thoracotomies often include individuals with severe lung diseases or chest trauma (Calligaro et al 2014 ; Clarke et al 2011 ). The standard surgical approach is the posterolateral incision which provides the best visibility of structures but results in significant post-operative pain compared with other incisions such as the anterolateral and muscle sparing techniques (Li et al 2014 ; Yamaqhuci, Hashimoto & Tamaki 2006 ). This approach is known to result in more shoulder dysfunction and post-operative pain in patients (El-Ansary et al 2016 ).…”

Section: Introductionmentioning

confidence: 99%

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Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

Schwellnus

Roos

Naidoo

2017

South African Journal of Physiotherapy

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BackgroundPhysiotherapy is included in the management of patients undergoing thoracic surgery. The aim of this study was to describe physiotherapy practice in the management of patients who undergo an open thoracotomy.MethodsA cross-sectional study using convenience sampling was undertaken. An electronic self-administered questionnaire was distributed via SurveyMonkey to 1389 physiotherapists registered with the South African Society of Physiotherapy in Gauteng. The data collection period was August and September 2014 and data were analysed descriptively.ResultsA total of 323 physiotherapists (23.3%) responded to the survey and 141 (10.2%) indicated that they treated patients with open thoracotomies. Preoperative treatment was done by 65 (41.6%) and consisted of teaching supported coughing (92.3%; n = 60), sustained maximal inspiration (70.8%; n = 46) and the active cycle of breathing technique (69.2%; n = 45). One hundred and sixteen (82.3%) respondents treated patients during their hospital stay. Deep breathing exercises (97.6%; n = 83), coughing (95.3%; n = 81), early mobilisation (95.3%; n = 81), upper limb mobility exercises (91.8%; n = 78), chest wall vibrations (88.2%; n = 75) and trunk mobility exercises (85.9%; n = 73) were done frequently. Pain management modalities were less common, for example transcutaneous electrical nerve stimulation (12.9%; n = 11). Post hospital physiotherapy management was uncommon (32.6%; n = 46).ConclusionPhysiotherapy related to early mobilisation in hospital is in line with evidence-based practice, but further education is needed regarding the need for physiotherapy post hospital discharge and pain management.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

Schwellnus

Roos

Naidoo

2017

South African Journal of Physiotherapy

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“…With the introduction of muscle-sparing and nerve-sparing incisions in thoracic surgery, pain due to rib or intercostal nerve trauma have been shown to be minimized [ 17 – 19 ]. However, despite the usage of such techniques, significant acute postoperative pain has still been reported after UVATS [ 21 , 22 ] and this is thought to be due to the irritation of the pleura or neurovascular bundles by chest tubes [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Tan

Mohamed

Tam

2021

J Cardiothorac Surg

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Background Well-controlled postoperative pain is essential for early recovery after uniportal video-assisted thoracoscopic surgery (UVATS). Conventional analgesia like opioids and thoracic epidural anaesthesia have been associated with hypotension and urinary retention. Intercostal catheters are a regional analgesic alternative that can be inserted during UVATS to avoid these adverse effects. This feasibility study aims to evaluate the postoperative pain scores and analgesic requirements with incorporation of an intercostal catheter into a multimodal analgesic strategy for UVATS. Methods In this observational study, 26 consecutive patients who underwent UVATS were administered a multilevel intercostal block and oral paracetamol. All of these patients received 0.2% ropivacaine continuously at 4 ml/h via an intercostal catheter at the level of the incision. Rescue analgesia including etoricoxib, gabapentin and opioids were prescribed using a pain ladder approach. Postoperative pain scores and analgesic usage were assessed. The secondary outcomes were postoperative complications, days to ambulation and length of stay. Results No technical difficulties were encountered during placement of the intercostal catheter. There was only one case of peri-catheter leakage. Mean pain score was 0.31 (range 0–2) on post-operative day 1 and was 0.00 by post-operative day 5. 16 patients (61.6%) required only oral rescue analgesia. The number of patients who required rescue non-opioids only increased from 1 in the first 7 months to 8 in the next 7 months. There were no cases of hypotension or urinary retention. Median time to ambulation was 1 day (range 1–2). Mean post-operative length of stay was 4.17 ± 2.50 days. Conclusions Incorporation of an intercostal catheter into a multimodal analgesia strategy for UVATS is feasible and may provide adequate pain control with decreased opioid usage.

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“…Surgery still remains the most commonly used therapy for early stage lung cancer patients [6]. Posterolateral thoracotomy (conventional thoracotomy) and muscle sparing thoracotomy(MST) [7–9] were thought to be the main method for a long time. Comparing with conventional thoracotomy, MST had better postoperative outcomes [10].…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

Wang¹,

Pang²,

Tang³

et al. 2019

BMC Surg

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Background It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. Methods PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. Results A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(− 2.28, − 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(− 1.18, − 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = − 43.87; 95%CI(− 73.66, − 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. Conclusion Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.

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Analysis of 11 Trials Comparing Muscle-Sparing with Posterolateral Thoracotomy

Abstract: MST may improve postoperative pain, but shows less effect on other perioperative parameters.

Cited by 25 publications

References 20 publications

Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

Physiotherapy management of patients undergoing thoracotomy procedure: A survey of current practice in Gauteng

Incorporation of an intercostal catheter into a multimodal analgesic strategy for uniportal video-assisted thoracoscopic surgery: a feasibility study

Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

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