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New Thoracotomy Closure, a Simple Way to Decrease Chronic Post-Operative Pain in Selected Patients-Blinded

Ioan Adrian Petrache1,2, Cristian Oancea3, Elisei Moise Hasan2

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A novel extra-costal (EC) chest closure technique significantly reduces chronic post-thoracotomy pain syndrome (PTPS) compared to standard peri-costal (PC) sutures. This nerve-sparing method offers a promising alternative for managing post-thoracic surgery pain.

Keywords:
chest closurechronic painpost-thoracotomy pain syndromethoracotomy

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Area of Science:

  • Thoracic Surgery
  • Pain Management
  • Surgical Techniques

Background:

  • Chronic post-thoracotomy pain syndrome (PTPS) is a frequent complication after thoracic surgery.
  • Chest closure technique is a significant risk factor for developing chronic pain.
  • Intercostal nerve damage from standard sutures contributes to PTPS.

Purpose of the Study:

  • To evaluate an alternative nerve-sparing extra-costal (EC) chest closure technique.
  • To minimize the risk of chronic pain following thoracic operations.
  • To compare EC closure with standard peri-costal (PC) and simple (SC) suture techniques.

Main Methods:

  • Prospective randomized study of 311 patients undergoing thoracic surgery.
  • Patients allocated to peri-costal (PC), extra-costal (EC), or simple (SC) closure groups.
  • Pain assessed using Visual Analogic Scale at multiple post-operative time points, including 6 months.

Main Results:

  • No significant pain difference between PC and EC groups in early post-operative days.
  • Significantly lower pain levels in the EC group at 5 days (3.5 ± 1.8) and 6 months (1.2 ± 1) versus PC group (5.3 ± 1.6, 3.2 ± 1.5).
  • No significant differences observed in other evaluated variables.

Conclusions:

  • Extra-costal chest closure demonstrates significantly reduced post-operative pain.
  • EC technique is easy to perform, similar to PC closure, with no significant increase in operative time.
  • This nerve-sparing approach may decrease PTPS incidence and associated healthcare costs.