Late sensory changes following chest drain insertion during thoracotomy

Area of Science:

• Pain Medicine
• Neurosurgery
• Thoracic Surgery

Background:

• Chest drains are known to cause acute pain, potentially contributing to persistent post-operative pain.
• Post-thoracotomy pain syndrome (PTPS) is a significant concern following thoracic surgery.
• Investigating chest drain sites is crucial for understanding PTPS development.

Purpose of the Study:

• To evaluate chest drain sites for pain and sensory dysfunction in PTPS patients.
• To compare sensory thresholds between chest drain insertion sites and contralateral sides.
• To determine the association between chest drains and persistent post-operative pain.

Main Methods:

• Quantified thermal and pressure detection thresholds on chest drain and control sides.
• Included 11 PTPS patients and 10 pain-free post-thoracotomy controls.
• Assessed patients 33 months after thoracotomy, with an average of two chest drains per patient.

Main Results:

• Significantly elevated warmth detection and heat pain thresholds on the chest drain side compared to the control side (P < 0.01).
• No significant differences in cool detection or pressure thresholds were observed.
• Only two patients reported pain directly from chest drain sites, despite all PTPS patients having incisional pain.

Conclusions:

• Elevated thermal detection thresholds suggest potential late nerve injury from chest drain insertion.
• No significant differences in sensory thresholds were found between PTPS and pain-free groups.
• The specific pathophysiological role of small fiber nerve injury from chest drains in PTPS remains unclear.