title: Anterior muscle and neurovascular-sparing thoracotomy and posterolateral thoracotomy: postoperative pain and morbidity assessment.
abstract: BACKGROUND
  We conducted this study to evaluate the thoracotomy approaches commonly used nowadays for treating thoracic pathologies and to decide whether it was necessary to make a choice between them for different situations. We used prospective analysis to compare hospital stay, analgesic usage, morbidity and postoperative chest pain between anterior muscle and neurovascular-sparing thoracotomy (AST) with disconnection of anterior rib cartilage, and serratus-sparing posterolateral thoracotomy (PLT). We also looked for a correlation between localization of the lesion and thoracotomy type for this factors.
  
  
  METHODS
  A total of 152 patients who had undergone a thoracotomy for major lung surgery from January through November 2011 were recruited in this study. Of these, 52 patients received AST and 100 underwent PLT. Location of the lesions in the thoracic cavity and all detected postoperative complications were documented. Postoperative chest pain was evaluated using a PIQ-6 pain questionnaire. Analgesic usage and duration of hospitalization were also noted.
  
  
  RESULTS
  Pain questionnaire scores were equivalent for both groups in all of the evaluations. Postoperative total median narcotic analgesic usage was lower in AST group than in PLT group. Complication rates were close in both groups. Median hospital stay was also shorter in patients who received AST.
  
  
  CONCLUSIONS
  We conclude that AST is a reasonable thoracotomy alternative to standard PLT for major lung surgery. But our study fails to demonstrate a clear advantage regarding postoperative pain and complications.
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Celikten
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sayar
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Metin
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Songul
authors.initials: S
authors.lastname: Buyukkale
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Necati
authors.initials: N
authors.lastname: Citak
authors.affiliation: Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, Turkey.
authors.forename: Atilla
authors.initials: A
authors.lastname: Gurses
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D064131:Back Muscles / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008168:Lung / Q000503:physiopathology / Q000601:surgery*; D008171:Lung Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics