• Ranjan Sapkota, Uttam Krishna Shrestha, and Prakash Sayami.
• Department of Cardiothoracic and Vascular Surgery, Manmohan Cardiothoracic Vascular and Transplant Center, Kathmandu, Nepal ranjansapkota@gmail.com.
• Asian Cardiovasc Thorac Ann. 2014 Jul 1; 22 (6): 706-11.

BackgroundThoracotomy 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.MethodA 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.ResultsTimes 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.Conclusionthese techniques lead to a reduction in the acute and chronic post-thoracotomy pain, without increasing complications.© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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