title: Combination of intracostal sutures with muscle flap to decrease post thoracotomy pain: A single blinded randomized clinical trial.
abstract: OBJECTIVE
  To assess the efficacy of intercostal nerve protection by intercostal muscle (ICM) flap in post-thoracotomy pain improvement compared to intracostal suturing.
  
  
  METHODS
  In a randomized controlled trial, ninety-four patients undergoing posterolateral thoracotomy surgery were divided into two subgroups. Intracostal sutures in isolation and in combination with ICM flap techniques were used for thoracotomy closure in both groups. Numeric Pain Scale and Visual Pain Scale as pain scores were assessed on the first, second, third, fourth, fifth, sixth and seventh postoperative days and follow-up visits during the 2ndweek, 1st, 2nd, 4thand 6thmonths after thoracotomy.
  
  
  RESULTS
  Out of 94 patients, 58 were male and 36 were females. While the mean age of patients in intracostal group was 45.3 ± 17.6 years, it was 47.4 ± 16.1 years in intracostal plus ICM flap group. The mean operation time for the first group was 191.0 ± 74.7 minutes, while it was 219.3 ± 68.8 minutes in the second (p>0.05). Numeric rating score and visual pain scale did not demonstrate any significant difference in pain severity on postoperative days and follow-up visits between both groups (p>0.05). Although the trend of pain reduction was significant in each group (p<0.001), the difference was not statistically significant (p>0.001).
  
  
  CONCLUSIONS
  Intracostal sutures in combination with muscle flap did not reduce postoperative pain in thoracotomy compared with intracostal sutures alone in thoracotomy closure.
authors.affiliation: Majid Montazer, Assistant Professor, Dept. of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Montazer
authors.affiliation: Shahryar Hashemzade, Professor, Dept. of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Shahryar
authors.initials: S
authors.lastname: Hashemzade
authors.affiliation: Reza Movassaghi Gargari, Assistant Professor, Dept. of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Reza Movassaghi
authors.initials: RM
authors.lastname: Gargari
authors.affiliation: Ali Ramouz, Research Fellow, Dept. of Cardiothoracic Surgery, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Ramouz
authors.affiliation: Sarvin Sanaie, Assistant Professor, Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Sarvin
authors.initials: S
authors.lastname: Sanaie
authors.affiliation: Seyed Ziaeddin Rasihashemi, Assistant Professor, Dept. of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Seyed Ziaeddin
authors.initials: SZ
authors.lastname: Rasihashemi
keywords: Intercostal muscle flap; Intracostal sutures; Postoperative pain; Thoracotomy