title: Rib approximation without intercostal nerve compression reduces post-thoracotomy pain: a prospective randomized study.
abstract: OBJECTIVE
  One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality.
  
  
  METHODS
  Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectively randomized into two groups, according to the thoracotomy closure techniques. In the first group (group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve.
  
  
  RESULTS
  There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically different in terms of the Ramsay sedation scores and von Frey hair tests.
  
  
  CONCLUSIONS
  Thoracotomy closure by a technique that avoids intercostal nerve compression significantly decreases post-thoracotomy pain.
authors.affiliation: Department of Thoracic Surgery, Uludag University, School of Medicine, Bursa, Turkey. asbayram2@yahoo.com
authors.forename: Ahmet Sami
authors.initials: AS
authors.lastname: Bayram
authors.forename: Metin
authors.initials: M
authors.lastname: Ozcan
authors.forename: Fatma Nur
authors.initials: FN
authors.lastname: Kaya
authors.forename: Cengiz
authors.initials: C
authors.lastname: Gebitekin
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods; D006801:Humans; D007366:Intercostal Muscles / Q000294:innervation / Q000601:surgery*; D007367:Intercostal Nerves / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control; D008875:Middle Aged; D009408:Nerve Compression Syndromes / Q000517:prevention & control*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D012272:Ribs / Q000601:surgery*; D013536:Suture Techniques; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods; D058106:Wound Closure Techniques