title: Intercostal muscle flap and intracostal suture to reduce post-thoracotomy pain.
abstract: BACKGROUND
  Thoracotomy is considered to be the most painful surgical access, the main culprit being intercostal nerve injury. Despite the use of many techniques, this remains a major problem, pointing towards prevention as a better strategy. The effect of protecting both the upper and lower intercostal nerves during surgery has attracted many researchers.
  
  
  METHODS
  A prospective study spanning 15 months was undertaken in 48 patients randomized to a conventional group (n = 25) and a study group (n = 23). Pericostal sutures in the former and intracostal sutures in the latter were used for closure. An intercostal muscle flap was harvested at the start of the operation in the study group only. The groups were comparable in terms of baseline characteristics. With a similar pain protocol, pain scores and analgesic consumption were recorded and analyzed.
  
  
  RESULTS
  Times for pedicle harvest, intracostal suture, and pericostal suture were 5.2 ± 1.56, 3.65 ± 0.71, and 6.4 ± 1.20 min, respectively, in the study group. Total operative time was similar in both groups. Postoperative pain scores and the overall frequency of pain were consistently lower in the study group.
  
  
  CONCLUSIONS
  these techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal ranjansapkota@gmail.com.
authors.forename: Ranjan
authors.initials: R
authors.lastname: Sapkota
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal.
authors.forename: Uttam Krishna
authors.initials: UK
authors.lastname: Shrestha
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal.
authors.forename: Prakash
authors.initials: P
authors.lastname: Sayami
mesh_terms: D059787:Acute Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007366:Intercostal Muscles / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009390:Nepal; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D013524:Surgical Flaps / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects; D013908:Thoracotomy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: Analgesics; pain; postoperative; thoracic surgical procedures