A study exploring the role of intercostal nerve damage in chronic pain after thoracic surgery

• Published in: European journal of cardio-thoracic surgery 2006-06, Vol.29 (6), p.873-879
• Main Authors: Maguire, Michael F., Latter, Janet A., Mahajan, Ravi, Beggs, F. David, Duffy, John P.
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Chronic Disease; Female; Humans; Intercostal Nerves - injuries; Intercostal Nerves - physiopathology; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative - methods; Neural Conduction; Pain Measurement - methods; Pain, Postoperative - etiology; Patient Selection; Pneumology; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Thoracotomy - adverse effects
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2006.03.031

Our aim was to investigate the prevalence of intra-operative nerve damage and its association with chronic pain. Our prospective study of 33 patients used nerve conduction studies to assess intercostal nerve function during elective thoracic surgical procedures. We used two methods to study nerve conduction: pre-operative magnetic stimulation (in 10 patients) and intra-operative nerve conduction studies (in all patients) We correlated these findings with specific intra-operative parameters, pain and psychological questionnaires pre-op and 3 month post-op and altered cutaneous sensation. Magstim (magnetic stimulation) assessments were not reliable and were therefore abandoned. Intraoperative intercostal nerve studies revealed two distinct patterns of nerve injury and also that nerve injury was less in those cases where a rib was not resected. However, intercostal nerve damage detected at the time of operation is not associated with chronic pain or altered cutaneous sensation at 3 months post-op. The study findings suggest that either the amount of intra-operative intercostal nerve damage is not indicative of long-term nerve damage or that there is a more significant cause for chronic pain other than intercostal nerve injury.