title: Intracostal sutures decrease the pain of thoracotomy.
abstract: BACKGROUND
  General thoracic surgeons spend much time dealing and treating patients' pain after thoracotomy.
  
  
  METHODS
  Two hundred eighty consecutive patients underwent elective thoracotomy for pulmonary resection. Patients with a history of chronic pain were excluded. One general thoracic surgeon performed all procedures. All patients had a functioning preoperative epidural, a skin incision the width of their latissimus dorsi muscle which was cut, sparing of the serratus anterior muscle, undercutting of the rib, preemptive analgesia of the intercostal nerve before rib spreading, and similar number of chest tubes and postoperative pain management. The first 140 patients had their chests closed with pericostal sutures (stitches placed on top of the fifth rib and on top of the seventh rib), and the next 140 patients had their chest closed with intracostal sutures (stitches placed on top of the fifth rib and through the small holes drilled in the bed of the sixth rib). Pain was objectified by a numeric pain score and by the McGill pain questionnaire at 2 weeks, and 1, 2, and 3 months postoperatively.
  
  
  RESULTS
  There were 140 patients in each group, and the groups were matched for age, gender, race, types of pulmonary resections, number of chest tubes, number of broken ribs, length of chest tube duration, and length of hospital stay (p > 0.05 for all). The mean pain score for the pericostal group (P group) at 2 weeks, 1 month, 2 months, and 3 months postoperatively was 5.5, 3.8, 2.3, and 1.6, respectively. For the intracostal group it was 3.3, 1.7, 1.1, and 0.6, respectively (p = 0.004, p = 0.0001, p < 0.0001, and p < 0.0001, respectively). Descriptors of pain in the P group were more likely to be, hot/burning, shooting or stabbing (p < 0.003).
  
  
  CONCLUSIONS
  Intracostal sutures seem to be less painful than pericostal sutures at 2 weeks, 1 month, 2 months, and 3 months after thoracotomy. The pain is less likely to be described as burning or shooting.
authors.affiliation: Department of Cardiothoracic Surgery, University of Alabama at Birmingham, 35294, USA. robert.cerfolio@ccc.uab.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cerfolio
authors.forename: Theolynn N
authors.initials: TN
authors.lastname: Price
authors.forename: Ayesha S
authors.initials: AS
authors.lastname: Bryant
authors.forename: Cynthia
authors.initials: C
authors.lastname: Sale Bass
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Bartolucci
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D013537:Sutures; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome