Biosorbable poly-L-lactide rib-connecting pins may reduce acute pain after thoracotomy.
OBJECTIVE
Conventional thoracotomy is currently used as a standard procedure, and is often required to treat numerous diseases. Additionally, rib resections are occasionally required to maintain an adequate field of view for surgery. The benefits of using rib pins for chest closure following such procedures have not yet been established. This study sought to evaluate the usefulness of rib pins in reducing acute postoperative pain.


METHODS
Thirty-three consecutive patients with lung cancer underwent lobectomies using the posterolateral approach. The patients were rib-resected and reconstructed with two techniques: 21 patients with absorbable rib pins (ARP group) and 12 patients by ligation with absorbable sutures (LAS group). Intensity of pain was assessed during the 3 days immediately following surgery. The two groups were assessed using the visual analogue scale (VAS) as a pain scale, amounts consumed of patient-controlled analgesics (PCA), and additional chest x-rays.


RESULTS
On the first day following surgery, the mean VAS intensity of the ARP group for patient motion was 2.71 +/- 2.14, compared to 5.33 +/- 2.99 in the LAS group. After three days, the mean score for the ARP group was 1.98 +/- 1.89, compared to 4.60 +/- 1.97 in the LAS group. Scores in the ARP group were significantly lower than in the LAS group one day and three days following thoracotomy. The LAS group (55.0 +/- 15.9 times) made more frequent requests than the ARP group (16.1 +/- 10.3 times). The PCA requirement was also significantly lower in the ARP group. Excessive derangement of the rib (grade 2) was found in one case (4.7 %) in the ARP group compared to five cases (41.6 %) in the LAS group. Rib shifts were seen in numerous cases in the LAS group compared to the ARP group as measured by chest x-rays.


CONCLUSIONS
Use of absorbable rib pins reduced postoperative pain and may improve long-term prospects for the post-thoracotomy course.
Iwasaki
A
A
Second Department of Surgery, School of Medicine, Fukuoka University, Japan. iwasaki@fukuoka-u.ac.jp
Hamatake
D
D
Shirakusa
T
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001858:Bone Nails; D005260:Female; D005592:Fracture Fixation; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000628:therapy*; D011091:Polyesters / Q000627:therapeutic use*; D012272:Ribs / Q000601:surgery*; D012720:Severity of Illness Index; D013536:Suture Techniques; D013908:Thoracotomy; D016896:Treatment Outcome
D000700:Analgesics; D001672:Biocompatible Materials; D011091:Polyesters; C033616:poly(lactide); D009020:Morphine