Department of Thoracic Surgery, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
J Bras Pneumol. 2014 Mar-Apr;40(2):164-70. doi: 10.1590/s1806-37132014000200010.
To evaluate whether the acute pain experienced during in-hospital recovery from thoracotomy can be effectively reduced by the use of intraoperative measures (dissection of the neurovascular bundle prior to the positioning of the Finochietto retractor and preservation of the intercostal nerve during closure).
We selected 40 patients who were candidates for elective thoracotomy in the Thoracic Surgery Department of the Federal University of São Paulo/Paulista School of Medicine, in the city of São Paulo, Brazil. The patients were randomized into two groups: conventional thoracotomy (CT, n = 20) and neurovascular bundle preservation (NBP, n = 20). All of the patients underwent thoracic epidural anesthesia and muscle-sparing thoracotomy. Pain intensity was assessed with a visual analog scale on postoperative days 1, 3, and 5, as well as by monitoring patient requests for/consumption of analgesics.
On postoperative day 5, the self-reported pain intensity was significantly lower in the NBP group than in the CT group (visual analog scale score, 1.50 vs. 3.29; p = 0.04). No significant differences were found between the groups regarding the number of requests for/consumption of analgesics.
In patients undergoing thoracotomy, protecting the neurovascular bundle prior to positioning the retractor and preserving the intercostal nerve during closure can minimize pain during in-hospital recovery.
评估术中措施（在放置 Finochietto 牵开器之前解剖神经血管束并在关闭时保留肋间神经）是否能有效减轻开胸术后住院期间的急性疼痛。
我们选择了巴西圣保罗市联邦大学/圣保罗医学院胸外科的 40 名择期开胸手术患者。患者随机分为两组：常规开胸术（CT，n=20）和神经血管束保护（NBP，n=20）。所有患者均接受胸椎硬膜外麻醉和肌保护开胸术。术后第 1、3 和 5 天，采用视觉模拟评分法评估疼痛强度，并监测患者对/使用镇痛药的请求。
术后第 5 天，NBP 组的自我报告疼痛强度明显低于 CT 组（视觉模拟评分，1.50 比 3.29；p=0.04）。两组在请求/使用镇痛药的次数方面无显著差异。
在接受开胸术的患者中，在放置牵开器之前保护神经血管束并在关闭时保留肋间神经，可以最大限度地减少住院期间的疼痛。
