• The Korean Journal of Pain
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• v.29 no.3
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• pp.189-192
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• 2016

Thoracotomy is a surgical technique used to reach the thoracic cavity. Management of pain due to thoracotomy is important in order to protect the operative respiratory reserves and decrease complications. For thoracotomy pain, blocks (such as thoracic epidural, paravertebral, etc.) and pleural catheterization and intravenous drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDs], and opioids, etc., can be used. We performed a serratus anterior plane (SAP) block followed by catheterization for thoracotomy pain. We used 20 ml 0.25% bupivacaine for analgesia in a patient who underwent wedge resection for a lung malignancy. We provided analgesia for a period of close to seven hours for the patient, whose postoperative VAS (visual analog scale) scores were recorded. We believe that an SAP block is effective and efficient for the management of pain after thoracotomy.

• Journal of Acupuncture Research
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• v.34 no.1
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• pp.81-87
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• 2017

Objectives : Chronic post-thoracotomy pain is a refractory condition that responds poorly to existing pain treatments. The aim of this report is to describe favorable symptom changes in a patient with chronic post-thoracotomy pain after major chest trauma who received a series of manual acupuncture treatments over 3 months. Methods : Twelve sessions of manual acupuncture were provided to the patient, once or twice a week. Results : The manual acupuncture sessions were well tolerated. Minor adverse events, including temporary minor bleeding at the needled sites, were intermittently observed. The patient's symptoms, including pain, sleep disturbance, and anxiety gradually resolved and had almost completely disappeared after 12 sessions of acupuncture treatment. Conclusion : This single case report cannot confirm whether the observed positive changes in the patient's symptoms and dysfunctions are associated with the acupuncture treatments. Randomized controlled trials are necessary to explore the role of acupuncture in chronic post-thoracotomy pain in patients with major chest trauma.

• The Korean Journal of Pain
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• v.32 no.2
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• pp.129-132
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• 2019

Regional anesthesia, including central and plane blocks (serratus anterior plane block and erector spinae block), are used for post-thoracotomy pain. The rhomboid intercostal block (RIB) is mainly performed by injection to the upper intercostal muscle plane below the rhomboid muscle. It has been reported to provide analgesia at the T3-T9 levels. The RIB was performed on 5 patients who had been scheduled for thoracotomy. The catheter was advanced in the area under the rhomboid muscle between the intercostal muscles. Postoperative visual analog scale (VAS) scores were observed and each patient's resting VAS score remained below 3 for 48 hours. The RIB has been observed to be a convenient plane block for post-thoracotomy analgesia. We believe that further information from detailed studies is required.

• Journal of Chest Surgery
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• v.27 no.11
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• pp.942-947
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• 1994

Post-thoracotomy pain is so severe that lead to postoperative pulmonary complications due to the patient`s inability to cough, deep breathing and chest wall motion. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1990, we reported the result that the cryoanalgesia reduce the immediate postoperative pain significantly. We try to compare the effect of cyroanalgesia with the effect of Bupivacain intercostal nerve block for the post-thoracotomy pain control. Ninety patients, who undergoing thoracotomy in Korea University Medical Center Guro Hospital between the January 1993 and September 1993, were evaluated. The patients were divided into three groups : Group A, control, the patients without pain control procedure [N=30], Group B, the patients with Bupivacain intercostal nerve block [N=30], Group C, the patients with cryoanalgesia [N=30]. Postoperative analgesic effects were evaluated by the scoring system which made arbiturary by author. The results were that the Bupivacain intercostal nerve block markedly reduced the immediate postoperative pain compare with two other groups, the cryoanalgesia reduced the immediate postoperative pain significantly compare with control group, the pain reduction effect of the two groups- cryoanalgesia and Bupivacain intercostal nerve block- were not different at postoperative seventh day, probably due to the action time of Bupivacain and the result that there were no significant complications of the procedures.

• Journal of Chest Surgery
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• v.26 no.10
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• pp.781-786
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• 1993

Effrctive analgesia after elective thoracotomy can be provided by continuous extrapleural intercostal nerve block.This study was designed to prove the effectiveness of continuous extrapleural intercostal nerve block. Twenty patients undergoing elective thoracotomy were randomized into two groups. Group I received lumbar epidural block[N=10] and group II received continuous extrapleural intercostal nerve block[N=10]. Postoperative pain relief was assessed on Numeric Rating Scale[NRS] and recovery of pulmonary function was assessed by coparison of preoperatrive and postoperative FVC[Forced Vital Capacity], FEV1[Forced expiratory Volume in 1 second], VC[Vital Capacity]. Arterial blood gas analysis[ABGA], vital signs and amount of additive analgesics were compared also. No significant difference was observed between the groups concerning these parameters mentioned above. Systemic complications, such as urinary retention[2/10] and weakness of lower extremity[2/10], occurred in group I but no complication occurred in group II. We conclude that continuous extrapleural intercostal nerve block is as effective as epidural block in pain relief and restoration of pulmonary mechanics with fewer comlications. Also because of it`s ease and safetiness, this must be considered as a substitute of epidural block in routine use for thoracotomy pain relief.

• Journal of Chest Surgery
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• v.27 no.12
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• pp.1008-1014
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• 1994

Increased interest in alternative approach to thoractomy has developed because of the considerable morbidity associated with the standard posterolateral thoracotomy[ST]. Muscle sparing thoracotomy is appeared as excellent alternative because of less postoperative pain and morbidity than standard posterolateral one. Vertical axillary muscle sparing thoracotomy[VM] is the newly revised modified muscle sparing thoracotomy that overcomes the disadvantages of previous lateral muscle sparing thoracotomy such as seroma, cosmetic problems, and need of subcutaneous drains. We conducted a prospective study of 45 consecutive patients to compare postoperative pain, muscle strength of serratus anterior and latissimus dorsi, and range of motion of the shoulder girdle between ST and VM group. There were no difference in preoperative status, surgical procedure, morbidity, mortality and hospital stay between two groups. But there were significant less postoperative narcotics requirements, more preserved latissimus dorsi and serratus anterior muscle strength, nd larger range of motion of shoulder girdle [ especially flexion and internal rotation in VM group. The opening time was prolonged[p<0.01] but closing time was less in VM group [p<0.01]. The sum of opening and closing time was not different in two group. The length of incision line was shorter in VM group. The vertical skin incision was concealed by the upper arm.In conclusion vertical axillary muscle sparing thoracotomy is good alternative for various intrathoracic procedures with less postoperative pain, well preserved muscle strength,increased range of motion of the shoulder girdle and impressive cosmetic outcome.

• The Korean Journal of Pain
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• v.32 no.2
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• pp.105-112
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• 2019

Background: Severe pain always develops after thoracotomy; intrapleural regional analgesia is used as a simple, safe technique to control it. This study was performed to evaluate whether a small dose of naloxone with local anesthetics prolongs sensory blockade. Methods: A prospective, randomized double-blinded controlled study was conducted on 60 patients of American Society of Anesthesiologists statuses I and II, aged 18 to 60 years, scheduled for unilateral thoracotomy surgery. After surgery, patients were randomly divided into two groups: through the intrapleural catheter, group B received 30 ml of 0.5% bupivacaine, while group N received 30 ml of 0.5% bupivacaine with 100 ng of naloxone. Postoperative pain was assessed using the visual analog pain scale (VAS). Time for the first request for rescue analgesia, total amount consumed, and incidence of postoperative complications were also recorded. Results: The VAS score significantly decreased in group N, at 6 h and 8 h after operation (P < 0.001 for both). At 12 h after injection, the VAS score increased significantly in group N (P < 0.001). The time for the first request of rescue analgesia was significantly longer in group N compared to group B (P < 0.001). The total amount of morphine consumed was significantly lower in group N than in the bupivacaine group (P < 0.001). Conclusions: Addition of a small dose of naloxone to bupivacaine in intrapleural regional analgesia significantly prolonged pain relief after thoracotomy and delayed the first request for rescue analgesia, without significant adverse effects.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.303-307
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• 1993

Postoperative pain relief and the side effects of epidurally injected morphine were investigated in 10 patients who received thoracotomy. Epidural morphine injection was given via an epidural catheter after thoracotomy. The pain score[VAS] and repiratory rate were decreased and the SaO2, tidal volume and vital capacity were increased significantly after epidural morphine injection. The analgesia of epidural morphine lasted for 13 hours with average. The side effects of epidural morphine were few and mild, but urinary retention was in 10%[1/10] of total patients.

• The Korean Journal of Pain
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• v.18 no.2
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• pp.181-186
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• 2005

Background: Hydromorphone has an intermediate lipid solubility range that falls between morphine and fentanyl. Lipophilic activity during opioid epidural administration is important in relation to both the side effects and analgesic efficacy. The purpose of this study was to compare epidural hydromorphone and fentanyl when concomitantly infused with bupivacaine in patients undergoing a thoracotomy. Methods: Seventy-seven thoracotomy patients, with patient-controlled epidural analgesia (PCEA), were blindly allocated into two groups [group F (n = 34); 0.1% bupivacaine and fentanyl $5{\mu}g/ml$, group H (n = 34); 0.1% bupivacaine and hydromorphone $16{\mu}g/ml$)]. The basal PCEA rate and demand dose were 4 ml/hr and 3 ml, respectively. The visual analogue scale (VAS) for pain, and pruritus, sedation and nausea were measured at 6, 12 and 24 hours after the operation. Results: There were no significant differences in the VAS pain scores and the incidences of pruritus, nausea and sedation between the two groups. The total infused volume after 24 hours was lower in H compared to that of F group (P < 0.05). Conclusions: We conclude that epidural hydromorphone or fentanyl administration has a similar analgesic efficacy and shows similar incidences of side effects, when concomitantly infused with bupivacaine, in the management of acute pain following a thoracotomy.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.538-542
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• 1993

An approach to the treatment of post-operative pain by the injection of bupivacaine into the pleural space through an intrapleural cathter has been studied. Among 24 thoracotomy patients, bupivacaine was injected only to experimental group[ 12 patients ] when the patient was able to head up for oneself during recovery from anesthesia. The pain and ROM[ range of motion ] scores, respiration rate, PaCO2 level of both experimental and control group were measured at the time of head-up and 30 and 120 minutes thereafter.The scores of pain and ROM of experimental group were significantly[ P value < 0.05 ] decreased in 30 minutes and 120 minutes after bupivacaine injection compared with those of control group but respiration rate and PaCO2 level were not changed significantly. With this result, we can suggest that intrapleural injection of bupivacaine is useful for pain relief following thoracotomy.