Posted on November 2, 2005 at 9:40 a.m.

BIRMINGHAM, Ala. – A simple variation in the standard technique used during lung surgery significantly reduces acute and chronic pain following surgery, according to a UAB study published in the October issue of The Journal of Thoracic and Cardiovascular Surgery. The technique is easy to perform, does not require additional special equipment and takes relatively little time — a major plus for speeding patient recovery.

UAB Chief of Thoracic Surgery Robert J. Cerfolio, M.D., and colleagues found that creating a muscle flap, so the intercostal nerve is spared and not injured before spreading the ribs, avoids crushing the nerve and greatly reduces pain after surgery. The muscle flap is reattached prior to closing the chest.

Pain was reduced both in the hospital and each week after surgery for the 12 weeks patients were followed in the study after discharge. The study showed patients who were operated on via the muscle flap technique had significantly improved lung function. By the third day following surgery, only 11 percent had decreased lung function, compared with 23 percent in the standardized group. Those who received the muscle flap procedure were less likely to require pain medications, with only 16 percent still using pain medication by week eight compared with 41 percent in the standard technique group. And, they were more likely to have returned to normal activities within a month, returning on average in three weeks compared with eight weeks in the standard technique group.

The study used sophisticated, objective measurements of pain, including three separate pain score surveys, and measurements of patients’ pain medication usage. In addition, the maximum volume of air a patient could inhale and exhale was measured each day in the hospital and each week at home, and showed that patients who received the intercostal muscle flap had greater air movement.

“Perhaps most important is that the decrease in pain, particularly during the first and second days of hospitalization, might allow patients to breathe deeper, which could reduce some respiratory complications such as pneumonia and mucous plugging, which remain significant and vexing problems after lung surgery,” Cerfolio said.

The idea for this simple technique was generated from an earlier study published in the Annals of Thoracic Surgery in 2004 by Cerfolio et al. “In the first study,” Cerfolio said, “we found a way to avoid injury to the same nerve during closure by drilling holes in the ribs so our closure stitches would not entrap that nerve. Then, we got the idea that maybe we could further reduce the pain by avoiding the nerve during opening and came up with the idea of harvesting the flap prior to chest retraction. As surgeons, we are constantly looking for ways to improve techniques and reduce pain.”

Eighty percent of patients with lung cancer have non-small cell lung cancer, which is potentially curable with surgical intervention if detected early and completely removed. A thoracotomy – surgically opening the side of the chest and spreading the ribs – is used almost exclusively by surgeons as the preferred method to remove cancerous parts of the lung. However, thoracotomy is associated with significant pain and post-surgical complications. Studies have shown that chronic pain (pain after six months) occurs in up to 67 percent of patients following a thoracotomy.