Intercostal Bundle-Splitting Thoracotomy Reduces Chronic Post-Thoracotomy Pain

Introduction

Chronic post-thoracotomy pain occurs in approximately 50 % of patients after thoracotomy, and is the most common postoperative complication [[1]]. Moreover, previous work has shown that intercostal nerve damage may be responsible for chronic post-thoracotomy pain [[2], [3]]. Some authors have advocated the placement of intracostal sutures (placed after drilling holes in the bottom rib) to avoid nerve impingement during closure [[4]]. However, this method does not provide a means of avoiding the nerve during rib spreading, and it takes time to set up the drill and console. We describe here a means of avoiding the intercostal nerve during rib spreading and closure without any additional equipment.

References

• 1 Rogers M L, Duffy J P. Surgical aspects of chronic post-thoracotomy pain.  Eur J Cardiothorac Surg. 2000;  18 711-716
• 2 Benedetti F, Amanzio M, Casadio C. et al . Postoperative pain and superficial abdominal reflexes after posterolateral thoracotomy.  Ann Thorac Surg. 1997;  64 207-210
• 3 Benedetti F, Vighetti S, Ricco C. et al . Neurophysiologic assessment of nerve impairment in posterolateral and muscle sparing thoracotomy.  J Thorac Cardiovasc Surg. 1998;  115 841-847
• 4 Cerfolio R J, Price T N, Bryant A S, Bass C S, Bartolucci A A. Intracostal sutures decrease the pain of thoracotomy.  Ann Thorac Surg. 2003;  76 407-412
• 5 Rogers M L, Henderson L, Mahajan R P, Duffy J P. Preliminary findings in the neurophysiological assessment of intercostals nerve injury during thoracotomy.  Eur J Cardiothorac Surg. 2002;  21 298-301