Intercostals Nerve Freezing Technique for Analgesia on Post-operative Chest: A Randomized Controlled Trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

Department of Thoracic Surgery, Zhongshan Hospital of Xiamen University, Xiameng 361003 Fujian, P. R. China;

Corresponding?author：

Keywords：

Intercostals nerve freezing; Open thoracic operation; Analgesia; Randomized controlled trial

DOI：

10.7507/1007-4848.20160009

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Objective To discuss the clinical effects of intercostals nerve freezing technique for analgesia on post-operative chest. Methods We included 80 patients with thoracotomy in Zhongshan Hospital in Xiamen University between June 2013 and June 2014. The patients were divided into a trial group (30 males and 10 females at average age of 59.90± 10.62 years) and a control groups (28 males and 12 females at average age of 59.85± 10.52 years) by random digital table. The patients in the trial group were treated with frozen the intercostals nerve roots located in the incision and next intercostals before closing the chest by cryotherapy therapy apparatus (K520 type, Beijing Kulan Company). The patients in the control group were treated with self-control intravenous analgesia pump post-operation. We compared the postoperative incision pain and cough, sputum reflection score, and pulmonary complications between the two groups. Results The pain degree in the trial group was significantly weaker than that in the control group on the first day, the second day and the seventh day after operation (t=-6.45, -4.95, -3.14, P < 0.05). Cough, sputum reflection score were significantly higher than those in the control group (P < 0.01). Pulmonary complications were significantly lower (t=3.023, P < 0.05). There were 4 patients with pneumonia and no pulmonary atelectasis in the trial group. While there were 8 patients with pneumonia in the control group and 1 patient with pulmonary atelectasis. Conclusion Intercostals nerve freezing technique can drastically reduce postoperative pain in the patients with open thoracic operation, effectively promote patient cough and expectoration, and reduce pulmonary complications rate.

Citation： HEJian-bing, DUANHong-bing, KANGJian-le, KESun-kui, WUZhao-hui, HEZhe-feng, LIMin-jie. Intercostals Nerve Freezing Technique for Analgesia on Post-operative Chest: A Randomized Controlled Trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(1): 34-37. doi: 10.7507/1007-4848.20160009 Copy

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12.	Walsh EM. Methods of post-thoracomy analgesia. Br Janaesth, 2002, 89(1):184-185.
13.	張曉, 郎保平.肋間神經止痛在開胸術中的應用.中華外科雜志, 2003, 8(8): 6-9.
14.	Mainwand MO, Makey AR. Cryoanalgesia aft er thoracotmy. J Thorac Cardiovasc Surg, 1986, 92: 291.
15.	Tovar EA. Minimally invasive approach for pneumonectomy culminating in an outpatient procedure. Chest, 1998, 114(5): 1454-1458.
16.	Moorjani N, Zhao F, Tian Y, et al. Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostals nerves: a human prospective random ized trial and a histological study. Eur J Cardiothorac Surg, 2001, 20(3): 502-507.
17.	龐文廣, 黃鳳柳, 葉敏.肋間神經冷凍術在胸部手術后鎮痛的臨床研究.中國現代醫生, 2011, 8(49) : 48-50.
18.	Topalski-Fistes N, Bujas M, Pjevi? M, et al. Infertility and endometriosis. Med Pregl, 1997, 50(1-2): 15-17.
19.	Kehlet H. Multimodal approach to control postoperative pathoph-ysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
20.	趙鳳瑞, 田燕雛, 劉德若, 等.肋間神經冷凍止痛的實驗及臨床研究.中華外科雜志, 2001, 39(11): 852-854.

1. 顧愷時, 主編.胸心外科手術學.北京:人民衛生出版社, 1985. 62.
2. 曾玉山, 黎萍.開胸術后肋間神經冷凍治療對術后切口鎮痛療效的臨床研究(附30例分析).吉林醫學, 2012, 4(11) : 2246-2248.
3. 郎保平, 陳國生, 張宇.開胸冷凍后不同鎮痛方法的療效比較分析.中國綜合臨床, 2003, 19(6): 540-541.
4. Wagner R, DeLeo JA, Heckman HM, et al. Peripheral nerve patho-logy following sciatic cryoneurolysis: relationship to neuropathic behaviors in the rat. Exp Neurol, 1995, 133(2): 256-264.
5. Callesen T, Beeh K, Thoru PJ, et al. Cryanalgesia: effect on posth-erniorrhaphy pain. Anesth Analg, 1998, 87(4): 896-899.
6. Nelson RM. Intraoperative intereostal nerve freezing to prevent post thoracotomy pain. Ann Thorac Surg, 1974, 18: 280.
7. 倪斌, 馬海濤, 秦涌, 等.鎮痛治療方法對開胸術后患者心肺并發癥的影響.中國疼痛醫學雜志, 2007, 13(6): 334-337.
8. 孫潔群, 蘇婉婷, 李佩賢.開胸術后冷凍肋間神經鎮痛效果的觀察與研究.當代醫學, 2008, 12(14): 44-45.
9. Kehlet H. Multimodal approach to control postoperative pathoph-ysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
10. Rogers ML, Duffy JP. Surgical aspects of chronic post-thoracotomy pain. Eur J Cardiothorac Surg, 2000, 18(6): 711-716.
11. Sandler AN. Post-thoracotomy analgesia and perioperative outcome. Minerva Anestesiol, 1999, 65(5): 267-274.
12. Walsh EM. Methods of post-thoracomy analgesia. Br Janaesth, 2002, 89(1):184-185.
13. 張曉, 郎保平.肋間神經止痛在開胸術中的應用.中華外科雜志, 2003, 8(8): 6-9.
14. Mainwand MO, Makey AR. Cryoanalgesia aft er thoracotmy. J Thorac Cardiovasc Surg, 1986, 92: 291.
15. Tovar EA. Minimally invasive approach for pneumonectomy culminating in an outpatient procedure. Chest, 1998, 114(5): 1454-1458.
16. Moorjani N, Zhao F, Tian Y, et al. Effects of cryoanalgesia on post-thoracotomy pain and on the structure of intercostals nerves: a human prospective random ized trial and a histological study. Eur J Cardiothorac Surg, 2001, 20(3): 502-507.
17. 龐文廣, 黃鳳柳, 葉敏.肋間神經冷凍術在胸部手術后鎮痛的臨床研究.中國現代醫生, 2011, 8(49) : 48-50.
18. Topalski-Fistes N, Bujas M, Pjevi? M, et al. Infertility and endometriosis. Med Pregl, 1997, 50(1-2): 15-17.
19. Kehlet H. Multimodal approach to control postoperative pathoph-ysiology and rehabilitation. Br J Anaesth, 1997, 78(5): 606-617.
20. 趙鳳瑞, 田燕雛, 劉德若, 等.肋間神經冷凍止痛的實驗及臨床研究.中華外科雜志, 2001, 39(11): 852-854.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Intercostals Nerve Freezing Technique for Analgesia on Post-operative Chest: A Randomized Controlled Trial

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