title: Impact of intercostal paravertebral neurectomy on post thoracotomy pain syndrome after thoracotomy in lung cancer patients: a randomized controlled trial.
abstract: BACKGROUND
  Thoracotomy leads to chronic neuropathic pain in up to 50% of patients and is responsible for an impaired quality of life. Intercostal nerve injury has been suggested to be responsible for this pain. In the present study the impact of paravertebral intercostal neurectomy on post thoracotomy pain was assessed.
  
  
  METHODS
  In this single center parallel-group randomized controlled trial patients underwent muscle sparing anterolateral thoracotomy and anatomical lung resection for lung cancer. A subcostal approach was used for thoracotomy with single paravertebral neurectomy being performed at the beginning of the procedure at the level of the retracted intercostal space. For documentation of neuropathic pain the Leeds Assessment Score for Neuropathic Symptoms and Signs (LANSS) was used postoperatively. The primary endpoint was defined as LANSS ≥12 points on day 120. In addition, the numeric pain rating scale (NRS) was used to score pain intensity.
  
  
  RESULTS
  Out of 172 patients initially randomized 161 patients were investigated following intraoperative and postoperative drop-out criteria. All patients required anatomical lung resection via thoracotomy. Five patients were lost for follow up. For the remaining 156 patients there was no difference between the two groups with regard to LANSS ≥12: 26.6% in patients with neurectomy and 28.8% in control-subjects (P=0.78). In addition, the NSR score at day 120 did not differ significantly at rest and during activity between the two groups (at rest: 21.7%vs. 15.8% P=0.439; activity: 24.5%vs. 21.9% P=0.735).
  
  
  CONCLUSIONS
  Neurectomy was not shown to reduce the post thoracotomy pain syndrome in patients with anatomical lung resection following anterolateral muscle sparing thoracotomy.
authors.affiliation: Department of Thoracic surgery, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Germany.
authors.forename: Aris
authors.initials: A
authors.lastname: Koryllos
authors.affiliation: Institute for Research in Operative Medicine (I.F.O.M.), Witten/Herdecke University, Cologne, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Althaus
authors.forename: Marcel
authors.initials: M
authors.lastname: Poels
authors.forename: Robin
authors.initials: R
authors.lastname: Joppich
authors.affiliation: Institute for Research in Operative Medicine (I.F.O.M.), Witten/Herdecke University, Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Frank
authors.initials: F
authors.lastname: Wappler
authors.forename: Wolfram
authors.initials: W
authors.lastname: Windisch
authors.affiliation: Department of Thoracic surgery, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Ludwig
authors.affiliation: Department of Thoracic surgery, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Faculty of Health/School of Medicine, Germany.
authors.forename: Erich
authors.initials: E
authors.lastname: Stoelben
keywords: Lung cancer; anterolateral thoracotomy; neurectomy; post-thoracotomy-pain syndrome