Ochroch E Andrew, Gottschalk Alan, Augoustides John G, Aukburg Stanley J, Kaiser Larry R, Shrager Joseph B
Department of Anesthesiology, University of Pennsylvania Health System, 3400 Spruce St, 680 Dulles, Philadelphia, PA 19104, USA.
Chest. 2005 Oct;128(4):2664-70. doi: 10.1378/chest.128.4.2664.
We set out to determine whether there is a difference in postoperative pain and recovery after the patient undergoes the axillary muscle-sparing incision (ie, muscle-sparing thoracotomy [MT]) vs the modified posterolateral incision (ie, posterolateral thoracotomy [PT]).
Analysis of a database originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy.
The Hospital of the University of Pennsylvania.
Patients presenting for lobectomy, segmentectomy, or bilobectomy.
Pain, physical activity, and the extent that pain interfered with activities following major thoracotomy were prospectively assessed with standard questionnaires (ie, the brief pain inventory and the Medical Outcomes Study 36-item short form) on postoperative days 1 to 5, and at postoperative weeks 4, 8, 12, 24, 36, and 48 by a blinded research assistant. Perioperative care was standardized and included patient-controlled thoracic epidural analgesia until thoracostomy tube removal.
Eighty-two subjects underwent MT and 38 subjects underwent PT during the 16-month accrual period. There were no significant differences in demographics. Pain reported during hospitalization and after hospital discharge did not differ with respect to incision type (p > or = 0.17). Postoperative physical activity levels were significantly less than those reported preoperatively, with a trend toward better functioning in the MT groups after 8 weeks. Incision type did not predict complications, morbidity, or mortality.
When comparing patients who had undergone vertical, axillary, wholly MT to those who had undergone modified serratus muscle-sparing PT, postoperative differences in pain were not apparent. One should not anticipate reduced pain or more rapid overall recovery following MT, at least when epidural analgesia is used aggressively for perioperative pain control.
我们旨在确定患者接受腋下肌肉保留切口（即肌肉保留开胸术[MT]）与改良后外侧切口（即后外侧开胸术[PT]）后，术后疼痛和恢复情况是否存在差异。
对最初收集的数据库进行分析，以确定硬膜外镇痛时机对开胸术后长期结局的影响。
宾夕法尼亚大学医院。
接受肺叶切除术、肺段切除术或双肺叶切除术的患者。
在术后第1至5天以及术后第4、8、12、24、36和48周，由一名盲法研究助理使用标准问卷（即简明疼痛量表和医学结局研究36项简表）前瞻性评估开胸术后的疼痛、身体活动情况以及疼痛对活动的干扰程度。围手术期护理标准化，包括患者自控胸段硬膜外镇痛直至胸腔引流管拔除。
在16个月的入组期内，82例受试者接受了MT，38例受试者接受了PT。人口统计学特征无显著差异。住院期间和出院后报告的疼痛在切口类型方面无差异（p≥0.17）。术后身体活动水平明显低于术前报告的水平，MT组在8周后有功能改善的趋势。切口类型不能预测并发症、发病率或死亡率。
比较接受垂直、腋下、完全MT的患者与接受改良保留锯肌PT的患者时，术后疼痛差异不明显。至少在积极使用硬膜外镇痛进行围手术期疼痛控制时，不应预期MT后疼痛减轻或总体恢复更快。
