Postoperative Pain and Superficial Abdominal Reflexes After Posterolateral Thoracotomy

Benedetti, Fabrizio; Amanzio, Martina; Casadio, Caterina; Filosso, Pier Luigi; Molinatti, M; Oliaro, A; Pischedda, F; Maggi, G

doi:10.1016/s0003-4975(97)82829-9

Cited by 90 publications

(48 citation statements)

References 4 publications

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“…However, it requires the operator to transect at least one (mostly latissimus dorsi) and sometimes more of the major chest wall muscles (trapezius, rhomboids, and serratus anterior). Additionally, it is associated with considerable morbidity, including significant postoperative pain, compromised lung function, and diminished function of the shoulder girdle [2][3][4]. Younger age makes these patients more vulnerable to these side effects.…”

Section: Introductionmentioning

confidence: 99%

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

et al. 2006

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Alternative approaches to the standard posterolateral incision for thoracotomy have been developed to minimize its postoperative pain and wound related side effects. Muscle-sparing (MS) thoracotomy has been a well-known substitution to the standard posterolateral thoracotomy for this purpose; however it has not been studied in the pediatric age group in detail. We studied retrospectively the patients with thoracotomy for non-cardiac, thoracic surgical procedures. Group 1 included the patients with standard posterolateral thoracotomy for the surgery. The patients with MS thoracotomy composed group 2. The related data were collected retrospectively. The early postoperative morbidities (time requiring for regaining shoulder girdle movement, extubation, intensive care unit stay, and hospital stay) and late musculoskeletal anomalies (scoliosis, elevation of the shoulder, winged scapula, asymmetry of the nipples) were compared between groups. A total of 90 patients were included in the study. Group 1 constituted 50 patients with an average age of 4.24 +/- 2.91 years. Group 2 included 40 patients with an average age of 4.20 +/- 2.92 years. Comparison of the demographics and the baseline characteristics of the patients were not different between groups. In comparison of operative characteristics, there was lesser morbidity in group 2 as re-exploration for bleeding, wound infection, wound healing and fewer intensive care unit and hospital stay days. Late follow-up revealed a significant increase in musculoskeletal deformities in group 1. We conclude that muscle-sparing incision should be preferred to the standard posterolateral thoracotomy in pediatric age.

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Section: Introductionmentioning

confidence: 99%

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

et al. 2006

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“…Thoracotomy, along with limb amputation, is considered to be the procedure that elicits the highest risk of severe chronic postoperative pain (5,9). In the development of PTPS, type A delta nerve fiber-mediated somatic pain produced by the direct injury to the thoracic wall and the sensitization of the central nervous system play an important role (5,10).…”

Section: Discussionmentioning

confidence: 99%

Electro-physiological evidence of intercostal nerve injury after thoracotomy: an experimental study in a sheep model

Zhang¹,

Schwabe²,

Krüger³

et al. 2017

J. Thorac. Dis.

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Background: Although intercostal nerve injury is one of the major causes for post-thoracotomy pain, the exact mechanisms are still unclear. We sought to evaluate the electro-physiological changes of intercostal nerve injury after thoracotomy in a sheep model. Methods:Adult sheep underwent thoracotomy in the sixth intercostal space by employing diathermy to superior border of the seventh rib. In two sheep, ribs were then spread using retractor spreading for a distance of 7 cm for 30 minutes. In the third sheep, thoracotomy was followed by harvesting intercostal muscles including the neurovascular bundle adjacent to inferior edge of the sixth rib. Thereafter, ribs were spread in the same way, but with the muscle flap dangled between the blades for intercostal nerve protection (dangling muscle flap technique). The nerve conduction velocity of the intercostal nerve was recorded before and after incision of intercostal muscles, immediately and 30 minutes after retractor placement and 30 minutes after removal of the retractor.Results: In the sheep undergoing conventional thoracotomy, the physiological conductivity of intercostal nerve was completely blocked immediately after retractor placement using the same stimulation intensity or even the supra-threshold intensity. The conduction block persisted for 30 minutes during the retractor placement and further 30 minutes after removal of the retractor. In contrast, intercostal nerve conduction was not impaired throughout the experiment with the dangling muscle flap technique. Conclusions:Our experiment provides electro-physiological evidence for intercostal nerve injury after thoracotomy. The injury is primarily attributed to mechanical compression caused by the rib retractor.

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“…Benedetti et al, 1997, assessed intercostal nerve impairment after posterolateral thoracotomy measuring the superficial abdominal reflexes using electrophysiological techniques. They found a close correlation between pain intensity after posterolateral thoracotomy, absence of abdominal reflexes and less effective opioid response; the higher pain intensity with the absence of reflexes may be due to a larger neuropathic component.…”

Section: Intercostal Nerve Impairment Assessmentmentioning

confidence: 99%

Chest Wall Paraesthesia After Thoracic Surgery

González¹,

Castro²,

Candela³

2012

Paresthesia

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Postoperative Pain and Superficial Abdominal Reflexes After Posterolateral Thoracotomy

Cited by 90 publications

References 4 publications

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

Muscle sparing thoracotomy in pediatric age: a comparative study with standard posterolateral thoracotomy

Electro-physiological evidence of intercostal nerve injury after thoracotomy: an experimental study in a sheep model

Chest Wall Paraesthesia After Thoracic Surgery

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