Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Thoracic Surgery II, Peking University School of Oncology, Beijing Cancer Hospital & Institute, No. 52, Fucheng Avenue, Haidian District, Beijing 100142, PR China.
Eur J Cardiothorac Surg. 2010 Apr;37(4):840-5. doi: 10.1016/j.ejcts.2009.11.004. Epub 2009 Dec 1.
Intracostal suture or intercostal muscle flap can reduce post-thoracotomy pain through the preservation of intercostal nerves below or above the incision. This study aims to test whether combining intracostal suture with intercostal muscle flap might achieve better pain relief than intracostal suture alone.
This study included 144 consecutive patients who underwent pulmonary resection. Eighty patients entered the trial but eight were excluded. Seventy-two patients were randomly assigned to a muscle flap group, in which the fifth intercostal muscle and neurovascular bundle were raised and intracostal suture on the sixth rib was applied. For the control group, only intracostal suturing on the sixth rib was done. All patients had a functional epidural placed, which were removed 24h after surgery. Differences on average numeric rating scale (aNRS) scores were assessed in an early post-operative period from day 1 to day 7 and a later period from week 2 to week 12, when patients were resting or coughing. The doses of oxycodone demand and hyperalgesia-related intercostal dermatomes (HIDs) were recorded for analysis.
No differences were noted between the two groups in terms of length and width of the incision, or duration of rib retraction. Neither in different time periods (early or late) nor the activity status (while resting or coughing) yielded a statistical difference on aNRS scores between the muscle flap group and the control group (muscle flap group vs control group: mean (95% confidence intervals) from d ay 1 to day 7, 4.42 (1.56-7.28) vs 4.79 (2.03-7.55) on coughing (p=0.282); median (inter-quartile range, IQR) from day 1 to day 7, 1.71 (0.86-3) vs 2.50 (1.16-3.12) while resting (p=0.279); median (IQR) from week 2 to week 12, 0.43 (0-0.86) vs 0.48 (0.06-1.20) on coughing (p=0.595); median (IQR) from week 2 to week 12, 0 (0-0.14) vs 0.05 (0-0.14) while resting (p=0.856)). No differences were found in total oxycodone consumption from day 1 to day 7 between the two groups (Z=-1.821, p=0.069). The rate of HIDs in each intercostal space and median number of HIDs were similar between the two groups on day 1 (p>0.05) and day 7 (p>0.05).
The combination of intracostal suture with intercostal muscle flap may not necessarily achieve better post-thoracotomy pain control than using intracostal suture alone.
通过保留切口下方或上方的肋间神经，肋间内缝合或肋间肌瓣可减轻开胸术后疼痛。本研究旨在测试肋间内缝合联合肋间肌瓣是否比单纯肋间内缝合能获得更好的止痛效果。
本研究纳入了 144 例接受肺切除术的连续患者。80 例患者入组，但 8 例被排除。72 例患者随机分为肌瓣组，提起第 5 肋间肌和神经血管束，并在第 6 肋应用肋间内缝合。对照组仅在第 6 肋行肋间内缝合。所有患者均放置了功能性硬膜外导管，术后 24 小时拔除。在术后早期（第 1 天至第 7 天）和后期（第 2 周至第 12 周，休息或咳嗽时）评估平均数字评分量表（aNRS）评分的差异，并记录羟考酮需求和与痛觉过敏相关的肋间皮区（HIDs）的剂量。
两组在切口长度和宽度、肋骨回缩时间方面无差异。无论是在不同时间（早期或晚期）还是在不同活动状态（休息或咳嗽时），肌瓣组和对照组的 aNRS 评分均无统计学差异（肌瓣组与对照组：第 1 天至第 7 天咳嗽时的平均（95%置信区间）为 4.42（1.56-7.28）比 4.79（2.03-7.55）（p=0.282）；第 1 天至第 7 天休息时的中位数（四分位距，IQR）为 1.71（0.86-3）比 2.50（1.16-3.12）（p=0.279）；第 2 周至第 12 周咳嗽时的中位数（IQR）为 0.43（0-0.86）比 0.48（0.06-1.20）（p=0.595）；第 2 周至第 12 周休息时的中位数（IQR）为 0（0-0.14）比 0.05（0-0.14）（p=0.856））。两组在第 1 天至第 7 天的羟考酮总消耗量上无差异（Z=-1.821，p=0.069）。两组在第 1 天（p>0.05）和第 7 天（p>0.05）各肋间皮区的 HIDs 发生率和中位数 HIDs 数相似。
肋间内缝合联合肋间肌瓣不一定比单纯肋间内缝合能获得更好的开胸术后疼痛控制效果。
