TY - JOUR
T1 - Pain and physical function are similar following axillary, muscle-sparing vs posterolateral thoracotomy
AU - Ochroch, E. Andrew
AU - Gottschalk, Alan
AU - Augoustides, John G.
AU - Aukburg, Stanley J.
AU - Kaiser, Larry R.
AU - Shrager, Joseph B.
N1 - Funding Information:
This research was supported in part by National Institutes of Health grants R01 NS041865 and K23 HD40914-02.
PY - 2005/10
Y1 - 2005/10
N2 - Study objectives: 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]). Design: Analysis of a database originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy Setting: The Hospital of the University of Pennsylvania. Patients: Patients presenting for lobectomy, segmentectomy, or bilobectomy. Measurements: 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. Results: 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 ≥ 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. Conclusions: 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.
AB - Study objectives: 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]). Design: Analysis of a database originally collected to determine the effect of the timing of epidural analgesia on long-term outcome after thoracotomy Setting: The Hospital of the University of Pennsylvania. Patients: Patients presenting for lobectomy, segmentectomy, or bilobectomy. Measurements: 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. Results: 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 ≥ 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. Conclusions: 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.
KW - Analgesia
KW - Epidural
KW - Incision
KW - Outcomes
KW - Perioperative
KW - Postoperative pain
KW - Thoracotomy
UR - http://www.scopus.com/inward/record.url?scp=27144443319&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27144443319&partnerID=8YFLogxK
U2 - 10.1378/chest.128.4.2664
DO - 10.1378/chest.128.4.2664
M3 - Article
C2 - 16236940
AN - SCOPUS:27144443319
SN - 0012-3692
VL - 128
SP - 2664
EP - 2670
JO - CHEST
JF - CHEST
IS - 4
ER -