The role of intercostal nerve preservation in acute pain control after thoracotomy.
OBJECTIVE
To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure).


METHODS
We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20) and neurovascular bundle preservation (NBP, n = 20). All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics.


RESULTS
On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04). No significant differences were found between the groups regarding the number of requests for/consumption of analgesics.


CONCLUSIONS
In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery.
Department of Thoracic Surgery, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Marco Aurélio
MA
Marchetti-Filho
Department of Thoracic Surgery, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Luiz Eduardo Villaça
LE
Leão
Department of Thoracic Surgery, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Altair da Silva
Ada S
Costa-Junior
D059787:Acute Pain / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D000698:Analgesia; D015360:Analgesia, Epidural; D006801:Humans; D007367:Intercostal Nerves / Q000601:surgery*; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D013536:Suture Techniques; D013908:Thoracotomy / Q000009:adverse effects* / Q000379:methods*; D058106:Wound Closure Techniques