Post Chest Surgery Pain Help – Intercostal Neurolysis

Thoracotomies have a horrible record for leaving people with significant pains. Freeing up scarred in nerves (neurolysis) offers respite.

Cappellari AM, Tiberio F, Alicandro G, Spagnoli D, Grimoldi N.
Intercostal neurolysis for the treatment of postsurgical thoracic pain: A case series. Muscle & nerve. 2018 Jul 11. in press

  • post-thoracotomy pain syndrome (PTPS)long term disabling condition
  • occurs in  5-80% cases and 1/3 of them last long term
  • 10 cases
  • In intercostal space, they used a tinel’s sign (pressure induces pain/tingling elsewhere) as a sign of nerve damage
  • Lack of ability to motor stimulate nerves confirmed it “side-to-side difference ≥ 50% in CMAP amplitude was considered consistent with local nerve injury”
  • >50% relief with nerve block (lidocaine 2%, 3-5 ml)  was confirmative

Not much on actual procedure except this:
” After fascial incision, the intercostal nerve was identified using a microscopic. The nerve always was pale upon visual inspection or hard upon palpation. We performed external neurolysis to separate it from scar and neighbouring fibrous tissues.” – ie freed it up from scar…

Also:

“When the nerve appeared transacted (in one case only), external neurolysis
was followed by epineurial repair consisting of nerve end-to-end suture. The
nerve was then protected by fatty tissue.” (I presume the latter was in all cases)

Results:

postchest_neurolysis

Comment – Makes sense to free up nerves. Unsure just what percentage of cases have these clear-cut findings but results are good.

 

 

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