Combination of intracostal sutures with muscle flap to decrease post thoracotomy pain: A single blinded randomized clinical trial

Abstract

Objective:To assess the efficacy of intercostal nerve protection by intercostal muscle (ICM) flap in post-thoracotomy pain improvement compared to intracostal suturing.Methods:In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2nd week, 1st, 2nd, 4th and 6th months after thoracotomy.Results:Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 ± 17.6 years, it was 47.4 ± 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 ± 74.7 minutes, while it was 219.3 ± 68.8 minutes in the second (p>0.05). Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups (p>0.05). Although the trend of pain reduction was significant in each group (p<0.001), the difference was not statistically significant (p>0.001).Conclusion:Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure.

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

“…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).…”

Post-thoracotomy pain and nerve protection: Back to the drawing board?

“…Several studies have reported decreased pain, whereas others have found no difference. [4][5][6][7] Should this trial signal the end of nerve-sparing thoracotomy techniques? The answer is unclear.…”

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

“…For decades, thoracic surgery has been evidenced as the most painful surgical procedure (Montazer et al. ). Thoracic surgery results in both post‐surgical pain (Mesbah et al.…”

“…Thoracic surgical approaches involve a number of pain-sensitive structures and are associated with a significant amount of trauma on multiple muscle layers, fascia, neurovascular bundles, bones, joints and parietal pleura (Chin et al 2016;Sparks & Stewart 2018). For decades, thoracic surgery has been evidenced as the most painful surgical procedure (Montazer et al 2017). Thoracic surgery results in both post-surgical pain (Mesbah et al 2016) and post-thoracotomy shoulder pain (Pipanmekaporn et al 2018).…”