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BACKGROUND:
Thoracotomy is associated with significant morbidity as well as pain.
METHODS:
This is a prospective randomized trial over a four month period. Patients were randomized to a standard (S group) posterior-lateral thoracotomy or an identical procedure except an intercostal muscle (ICM group) was harvested from the lower rib prior to chest retraction (to protect the intercostal nerve). To ensure an equal distribution, patients were stratified by race, gender, and type of pulmonary resection. Patients received similar pain management. Pain was assessed using multiple pain scores during hospitalization and after discharge. Outcomes assessed were pain scores, spirometric values, analgesic use and activity level.
RESULTS:
There were 114 patients. The median time for ICM harvesting was 3 minutes. The numeric pain scores were lower for the ICM group on post-operative day 1 and 2 and at weeks 1, 2, 3, 4, 8 and 12 (p<0.05 for all). In addition patients in the ICM group had a smaller decrease in spirometric values, were less likely to be using analgesics, and were more likely to have returned to normal activity.
CONCLUSIONS:
The harvesting of an intercostal muscle flap prior to chest retraction decreases the pain of thoracotomy and leads to a lower decrease in spirometry. In addition, patients have less pain at 1, 2, 3, 4, 8 and 12 weeks post-operatively and are less likely to be using narcotics. Finally, it offers a pedicled muscle flap that takes little time to harvest and is able to buttress all bronchi after lobectomy.