Impact of intercostal paravertebral neurectomy on post thoracotomy pain syndrome after thoracotomy in lung cancer patients: a randomized controlled trial

Abstract

Background: Thoracotomy leads to chronic neuropathic pain in up to 50% of patients and is responsible for an impaired quality of life. Intercostal nerve injury has been suggested to be responsible for this pain. In the present study the impact of paravertebral intercostal neurectomy on post thoracotomy pain was assessed.Methods: In this single center parallel-group randomized controlled trial patients underwent muscle sparing anterolateral thoracotomy and anatomical lung resection for lung cancer. A subcostal approach was used for thoracotomy with single paravertebral neurectomy being performed at the beginning of the procedure at the level of the retracted intercostal space. For documentation of neuropathic pain the Leeds Assessment Score for Neuropathic Symptoms and Signs (LANSS) was used postoperatively. The primary endpoint was defined as LANSS ≥12 points on day 120. In addition, the numeric pain rating scale (NRS) was used to score pain intensity.Results: Out of 172 patients initially randomized 161 patients were investigated following intraoperative and postoperative drop-out criteria. All patients required anatomical lung resection via thoracotomy. Five patients were lost for follow up. For the remaining 156 patients there was no difference between the two groups with regard to LANSS ≥12: 26.6 % in patients with neurectomy and 28.8% in control-subjects (P=0.78). In addition, the NSR score at day 120 did not differ significantly at rest and during activity between the two groups (at rest: 21.7% vs. 15.8% P=0.439; activity: 24.5% vs. 21.9% P=0.735). Conclusions:Neurectomy was not shown to reduce the post thoracotomy pain syndrome in patients with anatomical lung resection following anterolateral muscle sparing thoracotomy.

Cancer survivorship and opioid prescribing rates: A population‐based matched cohort study among individuals with and without a history of cancer

“…Prior research has shown indication of this among survivors of childhood cancer, who were found to have a significantly higher prevalence of pain compared with their siblings without a previous cancer diagnosis . Survivors may experience long‐term sequelae related to their diagnosis or treatment that cause persistent pain . As survivors become older, other reasons for chronic pain such as osteoarthritis become more likely.…”

“…12 Survivors may experience long-term sequelae related to their diagnosis or treatment that cause persistent pain. 33 As survivors become older, other reasons for chronic pain such as osteoarthritis become more likely. It is also possible that a higher rate of opioid prescribing among survivors is due to a dependency that originated from opioid use earlier in the disease trajectory.…”

Prognostic factors for chronic post‐surgical pain after lung and pleural surgery: a systematic review with meta‐analysis, meta‐regression and trial sequential analysis

“…After removal of 166 records, 56 that met the eligibility criteria were included (Fig. 1) [9, 11, 50–103]. Of the 56 included studies, 28 (50%) were randomised controlled trials, 16 (29%) prospective observational studies and 12 (21%) retrospective observational studies.…”