title: The role of intercostal nerve preservation in pain control after thoracotomy.
abstract: OBJECTIVE
  Pain control after thoracotomy is an important issue that affects the outcome in thoracic surgery. Intercostal nerve preservation (ICNP) has increased interest in the outcomes of conventional thoracotomy. The current study critically evaluates the role of preservation of the intercostal nerve in early and late pain control and its benefit in patients undergoing thoracotomy.
  
  
  METHODS
  Data obtained prospectively between January 2006 and December 2010 by a study colleague at our division of General Thoracic Surgery were retrospectively analysed. There were 491 patients who underwent thoracotomy. Eighty-one patients were excluded from the study due to incompatible data. Patients were divided into two groups according to the intercostal nerve state: Group I consisted of patients with ICNP and Group II consisted of patients with intercostal nerve sacrifice.
  
  
  RESULTS
  Group I consisted of 288 patients [206 male (71%), P < 0.001, mean age 66 years]. Group II consisted of 122 patients [79 male (64%), P = 0.001, mean age 66 years]. There was less use of opiate in Group I (P = 0.019). Early mobilization of the patients was significantly higher in Group I (P = 0.031). The rate of pneumonia and re-admission to the intensive care unit was higher in Group II (P = 0.017 and 0.023, respectively). The rate of pain-free patients at discharge was significantly higher in Group I (P = 0.028). A 2-week follow-up after hospital discharge showed parasternal hypoesthesia to be more in Group II (P = 0.034). Significant patient contentment in Group I was noticed (P = 0.014). Chronic post-thoracotomy pain (CPTP) was higher in Group II (P = 0.016).
  
  
  CONCLUSIONS
  ICNP without harvesting an intercostal muscle flap achieves excellent outcomes in controlling acute post-thoracotomy pain and CPTP. ICNP is an effective, simple method to perform, and it should be considered as standard in performing thoracotomy.
authors.affiliation: Division of General Thoracic Surgery, Center of Pulmonary Diseases, Evangelic Hospital Bielefeld, Bielefeld, Germany.
authors.forename: Olga
authors.initials: O
authors.lastname: Koop
authors.forename: Andreas
authors.initials: A
authors.lastname: Gries
authors.forename: Stefan
authors.initials: S
authors.lastname: Eckert
authors.forename: Susanne
authors.initials: S
authors.lastname: Ellermeier
authors.forename: Beatrix
authors.initials: B
authors.lastname: Hoksch
authors.forename: Detlev
authors.initials: D
authors.lastname: Branscheid
authors.forename: Morris
authors.initials: M
authors.lastname: Beshay
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007367:Intercostal Nerves / Q000293:injuries*; D008297:Male; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local