1) The study evaluated intercostal nerve damage from chest tube insertion using current perception threshold testing in 16 patients undergoing thoracic surgery.
2) The results found that current perception thresholds were significantly higher after surgery than before, indicating worsening intercostal nerve function from chest tube insertion.
3) Pain scores significantly decreased after chest tube removal, showing that chest tube insertion contributed to post-operative pain.
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
The document analyzes data from 41 lobectomy patients to investigate correlations between epidural duration, chest tube drainage time, cancer type, lobe location, and risk of urinary retention. It finds that the epidural and chest tube durations were lower than national averages. While cancer type may indicate chest tube drainage time, epidural length and risk of urinary retention do not seem to correlate with cancer type or lobe location based on the limited sample size. A larger data set is needed to better understand relationships between these factors and patient outcomes.
This randomized controlled trial compared the success rates of real-time ultrasound-guided (USRTG) spinal anesthesia versus ultrasound-assisted (USAS) spinal anesthesia in elderly patients undergoing hip fracture surgery. The study found that the USAS technique had higher first-attempt and first-pass success rates, fewer attempts and passes, and higher patient satisfaction scores compared to the USRTG technique. While the USRTG technique had a shorter needle location time, it had a longer overall procedure time and was considered more difficult by anesthesiologists. The study concluded that for elderly hip fracture patients, USAS spinal anesthesia may be more suitable than USRTG due to its higher success rate and ease of use.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
A comparison of 2 cpm protocols after total knee arthroplastyFUAD HAZIME
1. The study compared outcomes of two continuous passive motion (CPM) protocols (standard vs early flexion) and a no-CPM control group following total knee arthroplasty.
2. The early flexion CPM group had significantly greater range of flexion than the other groups at 5 days post-op but there were no other significant differences between groups.
3. While early flexion CPM resulted in better short-term range of motion, the study found no substantial benefits of either CPM protocol over no CPM for other outcomes like length of stay, wound healing, or function.
Coblation nucleoplasty is a minimally invasive technique that uses radiofrequency energy to remove nucleus pulposus material from herniated lumbar discs. Several studies found that coblation nucleoplasty provided significant short and long-term relief of radicular pain and improved function in patients with contained disc herniations. Larger and longer term studies are still needed but initial results suggest coblation nucleoplasty is a safe and effective alternative to open discectomy for carefully selected patients.
This study evaluated the early rehabilitation effects of percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniations. 91 patients underwent PTED and were followed for 6 months. Results showed significantly reduced low back and leg pain based on VAS and ODI scores after surgery compared to before. No significant differences in low back pain scores at 3 days, 3 months, and 6 months post-op were found. PTED resulted in less trauma, fewer complications, and markedly shortened postoperative rehabilitation time, demonstrating it is a safe and effective treatment for lumbar disc herniations.
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma-Cri...CrimsonPublishersOPROJ
CT-Guided Percutaneous Radiofrequency Thermal Ablation of Osteoid Osteoma by Pedro Manuel Serrano* in Crimson Publishers: Orthopedic Research and Reviews Journal
The document analyzes data from 41 lobectomy patients to investigate correlations between epidural duration, chest tube drainage time, cancer type, lobe location, and risk of urinary retention. It finds that the epidural and chest tube durations were lower than national averages. While cancer type may indicate chest tube drainage time, epidural length and risk of urinary retention do not seem to correlate with cancer type or lobe location based on the limited sample size. A larger data set is needed to better understand relationships between these factors and patient outcomes.
This randomized controlled trial compared the success rates of real-time ultrasound-guided (USRTG) spinal anesthesia versus ultrasound-assisted (USAS) spinal anesthesia in elderly patients undergoing hip fracture surgery. The study found that the USAS technique had higher first-attempt and first-pass success rates, fewer attempts and passes, and higher patient satisfaction scores compared to the USRTG technique. While the USRTG technique had a shorter needle location time, it had a longer overall procedure time and was considered more difficult by anesthesiologists. The study concluded that for elderly hip fracture patients, USAS spinal anesthesia may be more suitable than USRTG due to its higher success rate and ease of use.
Analysis of Spinal Decompression via Surgical Methods and Traction TherapyPaige Barrett
This document summarizes various surgical and non-surgical methods for spinal decompression to treat back pain. For surgical decompression of the cervical spine, early surgery (<24 hrs) after spinal cord injury produces better outcomes than delayed surgery. Circumferential decompression and fusion is effective for cervical myelopathy. In the thoracic spine, posterior decompression with instrumented fusion improves neurological functioning for thoracic myelopathy. Video-assisted thoracoscopic surgery and percutaneous laser disc decompression are suitable minimally invasive options for the thoracic spine. For the lumbar spine, indirect decompression using an interbody cage is effective for degenerative lumbar stenosis, while decompression without fusion significantly decreases leg pain and disability. Minimally invasive
A comparison of 2 cpm protocols after total knee arthroplastyFUAD HAZIME
1. The study compared outcomes of two continuous passive motion (CPM) protocols (standard vs early flexion) and a no-CPM control group following total knee arthroplasty.
2. The early flexion CPM group had significantly greater range of flexion than the other groups at 5 days post-op but there were no other significant differences between groups.
3. While early flexion CPM resulted in better short-term range of motion, the study found no substantial benefits of either CPM protocol over no CPM for other outcomes like length of stay, wound healing, or function.
Coblation nucleoplasty is a minimally invasive technique that uses radiofrequency energy to remove nucleus pulposus material from herniated lumbar discs. Several studies found that coblation nucleoplasty provided significant short and long-term relief of radicular pain and improved function in patients with contained disc herniations. Larger and longer term studies are still needed but initial results suggest coblation nucleoplasty is a safe and effective alternative to open discectomy for carefully selected patients.
CT-Guided Percutaneous Pulse-Dose Radiofrequency for Pudendal NeuralgiaJason Attaman
This document describes a study evaluating CT-guided pulse-dose radiofrequency (PDRF) for treating pudendal neuralgia (PN). 30 patients with PN were treated with PDRF of the pudendal nerve under CT guidance. Patients reported significant reductions in pain after 1 week, with further reductions at 6 months and 1 year. The study concluded that CT-guided PDRF should be recommended for PN due to satisfactory results and tolerability of the procedure.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
This study evaluated the outcome of immediately loading 15 dental implants in 4 patients over a mean follow-up period of 4.8 months. The mean marginal bone loss from implant surgery to immediate loading was 0.03 ± 0.07 mm, and 0.16 ± 0.17 mm after 3 months of continued loading. No implants failed, resulting in a 100% survival rate. The results suggest that immediate loading of dental implants can achieve high success rates of up to 6 months. However, long-term clinical studies with larger sample sizes are still needed.
Effects of cold application on pain & anxiety during chest tube removal among...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Microwave ablation was used to treat epiphyseal osteoid osteomas in 7 patients. All patients experienced complete pain relief within 1 week of the procedure and had no complications, except for 1 patient who experienced back pain for 2 months. MRI scans after treatment showed ablation areas averaging 21 x 12 x 14 mm. The study demonstrated that microwave ablation can safely and effectively treat epiphyseal osteoid osteomas with a single needle insertion and without complications. However, more research with larger patient groups is still needed to validate these promising initial results.
Tips and tricks to site and maintain nerve cathetersAmit Pawa
This lecture was given on Friday 13th September 2019 at the annual congress of the European Society of Regional Anaesthesia in Bilbao and Spain. The talk was also contributed to by the Twitter Community. Strategies and techniques to site, secure and maintain perineural nerve catheters is discussed
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
- The document summarizes a landmark study on the timing of surgery for acute spinal cord injuries.
- The study randomized 64 patients with cervical spinal cord trauma to either early surgery (<72 hours) or late surgery (>5 days).
- The study found no significant differences in neurological or functional outcomes between early and late surgery groups.
- While the study provides evidence that waiting over 72 hours does not negatively impact outcomes, critics note that surgery within the first 24 hours may still provide benefits not captured by this study.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
once upon a time 12345once upon a t..pptxMinaz Patel
This study evaluated the performance of the VL3 video laryngoscope for intubation. It observed 35 patients undergoing elective surgery requiring intubation. The mean intubation time was 24.7 seconds. Most patients (57%) had an intubation difficulty score of 0, indicating easy intubation. Most patients (86%) had a glottic view score of 100%, allowing full view of the vocal cords. Hemodynamic parameters like heart rate and blood pressure did not change significantly from baseline values during intubation. The study concluded that the VL3 provided quick and easy intubation without significant hemodynamic response.
A case report of open reduction, internal fixation and platting of clavicle f...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses treatment options for a 35-year-old male patient suffering from neck pain radiating to his left arm for 6 months. It outlines conservative care, steroid injections, percutaneous disc decompression, endoscopic discectomy, and fusion as potential treatment options. Cervical nucleoplasty is highlighted as a minimally invasive procedure for contained disc herniations that provides significant and long-lasting pain relief based on clinical studies and the author's experience treating over 80 patients. The technique is described as a safe and controlled method of disc decompression using Coblation technology.
Duke OHNS Lumbar Drain AN Poster 44x44 vfinalMatthew Crowson
- The study examines whether the pre-operative use of a lumbar drain reduces post-operative cerebrospinal fluid leaks in patients undergoing acoustic neuroma resection.
- 282 patients were included in the study, with 220 receiving a pre-operative lumbar drain and 62 not receiving one. No significant difference was found in CSF leak rates between the two groups.
- While CSF leaks are a common complication, the routine use of pre-operative lumbar drains is not recommended due to the 5.3% complication rate associated with lumbar drain use and no evidence that it decreases CSF leak rates.
This document describes a study evaluating the efficacy of using a dynamic hip screw (DHS) drill under image intensifier guidance to ablate osteoid osteoma of the lower extremities in children and adolescents. Eighteen patients between ages 4-16 were treated with this minimally invasive technique, with 16 achieving initial success from one drilling. Complications included one tibial fracture and two skin abrasions. At follow-up, all patients were classified as having a good clinical response. The combination of intraoperative localization using image intensifier guidance and ablation with a DHS drill provided an efficient, safe, and curative procedure with minimal bone loss for treating osteoid osteoma.
Outpatient surgery benefits patients and surgeons alike, as it is convenient, safe and cost-effective. We sought to assess the safety and feasibility of daycare thyroid surgery in a stand-alone Daycare Surgery Center in South India.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
1. This document describes a study protocol to evaluate if pre-procedural ultrasound of the lumbar spine can improve the procedural skill of performing subarachnoid blocks.
2. The study aims to compare outcomes like success on the first needle pass, number of needle passes, time taken between groups who receive pre-procedure ultrasound versus those who do not.
3. A review of previous literature found that ultrasound can help identify anatomy like the posterior longitudinal ligament that indicates ease of dural puncture, and may help predict difficult procedures. Simulation training and deliberate practice was also found to improve residents' skills in performing subarachnoid blocks.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
Ligation-assisted endoscopic enucleation for the diagnosis and resection of s...Enrique Moreno Gonzalez
Ligation-assisted endoscopic enucleation (EE-L) was developed for the pathological
diagnosis and resection of small gastrointestinal tumors originating from the muscularis
propria. The technique combines endoscopic band ligation and endoscopic enucleation. The aim of this study was to evaluate the efficacy and safety of EE-L in the diagnosis and
resection of gastrointestinal tumors originating from the muscularis propria.
CT-Guided Percutaneous Pulse-Dose Radiofrequency for Pudendal NeuralgiaJason Attaman
This document describes a study evaluating CT-guided pulse-dose radiofrequency (PDRF) for treating pudendal neuralgia (PN). 30 patients with PN were treated with PDRF of the pudendal nerve under CT guidance. Patients reported significant reductions in pain after 1 week, with further reductions at 6 months and 1 year. The study concluded that CT-guided PDRF should be recommended for PN due to satisfactory results and tolerability of the procedure.
The study compared cervical laminoplasty using piezosurgery osteotomy versus high-speed drilling in 60 patients. Piezosurgery osteotomy resulted in less intraoperative blood loss and postoperative drainage. Both groups showed improved JOA scores after surgery with no significant differences in outcomes. Piezosurgery osteotomy may be superior for operation time, blood loss, and drainage while providing similar safety and efficacy as high-speed drilling for cervical laminoplasty.
This study evaluated the outcome of immediately loading 15 dental implants in 4 patients over a mean follow-up period of 4.8 months. The mean marginal bone loss from implant surgery to immediate loading was 0.03 ± 0.07 mm, and 0.16 ± 0.17 mm after 3 months of continued loading. No implants failed, resulting in a 100% survival rate. The results suggest that immediate loading of dental implants can achieve high success rates of up to 6 months. However, long-term clinical studies with larger sample sizes are still needed.
Effects of cold application on pain & anxiety during chest tube removal among...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
Microwave ablation was used to treat epiphyseal osteoid osteomas in 7 patients. All patients experienced complete pain relief within 1 week of the procedure and had no complications, except for 1 patient who experienced back pain for 2 months. MRI scans after treatment showed ablation areas averaging 21 x 12 x 14 mm. The study demonstrated that microwave ablation can safely and effectively treat epiphyseal osteoid osteomas with a single needle insertion and without complications. However, more research with larger patient groups is still needed to validate these promising initial results.
Tips and tricks to site and maintain nerve cathetersAmit Pawa
This lecture was given on Friday 13th September 2019 at the annual congress of the European Society of Regional Anaesthesia in Bilbao and Spain. The talk was also contributed to by the Twitter Community. Strategies and techniques to site, secure and maintain perineural nerve catheters is discussed
Effect of Intravenous Dexmedetomidine on Prolongation of Intrathecal Spinal A...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
- The document summarizes a landmark study on the timing of surgery for acute spinal cord injuries.
- The study randomized 64 patients with cervical spinal cord trauma to either early surgery (<72 hours) or late surgery (>5 days).
- The study found no significant differences in neurological or functional outcomes between early and late surgery groups.
- While the study provides evidence that waiting over 72 hours does not negatively impact outcomes, critics note that surgery within the first 24 hours may still provide benefits not captured by this study.
Postoperative pain is a major concern for patients and doctors. This preliminary study investigated the use of a wearable pulsed radiofrequency energy (PRFE) device to control postoperative pain in 18 women undergoing breast augmentation surgery. Patients were randomly assigned to receive either an active or placebo PRFE device. Those receiving the active device experienced significantly lower pain scores over 7 days as measured by a visual analog scale. They also took fewer narcotic pain medications than those receiving the placebo. The findings suggest PRFE therapy is an effective non-drug method for controlling postoperative pain.
once upon a time 12345once upon a t..pptxMinaz Patel
This study evaluated the performance of the VL3 video laryngoscope for intubation. It observed 35 patients undergoing elective surgery requiring intubation. The mean intubation time was 24.7 seconds. Most patients (57%) had an intubation difficulty score of 0, indicating easy intubation. Most patients (86%) had a glottic view score of 100%, allowing full view of the vocal cords. Hemodynamic parameters like heart rate and blood pressure did not change significantly from baseline values during intubation. The study concluded that the VL3 provided quick and easy intubation without significant hemodynamic response.
A case report of open reduction, internal fixation and platting of clavicle f...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses treatment options for a 35-year-old male patient suffering from neck pain radiating to his left arm for 6 months. It outlines conservative care, steroid injections, percutaneous disc decompression, endoscopic discectomy, and fusion as potential treatment options. Cervical nucleoplasty is highlighted as a minimally invasive procedure for contained disc herniations that provides significant and long-lasting pain relief based on clinical studies and the author's experience treating over 80 patients. The technique is described as a safe and controlled method of disc decompression using Coblation technology.
Duke OHNS Lumbar Drain AN Poster 44x44 vfinalMatthew Crowson
- The study examines whether the pre-operative use of a lumbar drain reduces post-operative cerebrospinal fluid leaks in patients undergoing acoustic neuroma resection.
- 282 patients were included in the study, with 220 receiving a pre-operative lumbar drain and 62 not receiving one. No significant difference was found in CSF leak rates between the two groups.
- While CSF leaks are a common complication, the routine use of pre-operative lumbar drains is not recommended due to the 5.3% complication rate associated with lumbar drain use and no evidence that it decreases CSF leak rates.
This document describes a study evaluating the efficacy of using a dynamic hip screw (DHS) drill under image intensifier guidance to ablate osteoid osteoma of the lower extremities in children and adolescents. Eighteen patients between ages 4-16 were treated with this minimally invasive technique, with 16 achieving initial success from one drilling. Complications included one tibial fracture and two skin abrasions. At follow-up, all patients were classified as having a good clinical response. The combination of intraoperative localization using image intensifier guidance and ablation with a DHS drill provided an efficient, safe, and curative procedure with minimal bone loss for treating osteoid osteoma.
Outpatient surgery benefits patients and surgeons alike, as it is convenient, safe and cost-effective. We sought to assess the safety and feasibility of daycare thyroid surgery in a stand-alone Daycare Surgery Center in South India.
2011 clinical outcome of dental implants placed with high insertion torquesMuaiyed Mahmoud Buzayan
This study evaluated 42 dental implants placed with high insertion torques of 70 Ncm or greater. All implants successfully integrated clinically and were stable after 1 year of loading. Marginal bone loss after 1 year was similar between implants placed with high torques (mean 1.24 mm) and low torques (mean 1.09 mm), indicating that high insertion torques did not negatively impact osseointegration or bone stability. The use of high insertion torques up to 176 Ncm did not prevent osseointegration and resulted in similar bone stability outcomes compared to lower torque implants.
1. This document describes a study protocol to evaluate if pre-procedural ultrasound of the lumbar spine can improve the procedural skill of performing subarachnoid blocks.
2. The study aims to compare outcomes like success on the first needle pass, number of needle passes, time taken between groups who receive pre-procedure ultrasound versus those who do not.
3. A review of previous literature found that ultrasound can help identify anatomy like the posterior longitudinal ligament that indicates ease of dural puncture, and may help predict difficult procedures. Simulation training and deliberate practice was also found to improve residents' skills in performing subarachnoid blocks.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
Ligation-assisted endoscopic enucleation for the diagnosis and resection of s...Enrique Moreno Gonzalez
Ligation-assisted endoscopic enucleation (EE-L) was developed for the pathological
diagnosis and resection of small gastrointestinal tumors originating from the muscularis
propria. The technique combines endoscopic band ligation and endoscopic enucleation. The aim of this study was to evaluate the efficacy and safety of EE-L in the diagnosis and
resection of gastrointestinal tumors originating from the muscularis propria.
This document discusses management of chest tubes after surgery for pneumothorax. There is limited evidence on whether suction or no suction is preferred. Some studies found benefits to no suction like shorter drainage duration, while others found no differences. New digital drainage systems can provide regulated suction to maintain a stable pressure, but more research is needed on pressure's role in healing. One small study found suction after surgery for pneumothorax resulted in longer chest tube duration and hospital stay compared to no suction. In general, the optimal management of chest tubes in these patients remains uncertain.
This survey examined cardiothoracic surgeons' and nurses' experiences with chest tube selection and management. It found that clogging is a major concern influencing surgeons to choose larger chest tube sizes. The majority of respondents had observed chest tube clogging and associated adverse patient outcomes. Despite techniques used to clear clogs like stripping, tapping and squeezing tubes, over half of surgeons were unsatisfied with currently available tubes and procedures to prevent occlusion. Both groups noted patients experience more discomfort with larger drain sizes. The survey highlights frequent problems with clogging and the need for innovative solutions to improve patient care and safety regarding chest tube drainage.
This document summarizes a letter to the editor in response to a recent systematic review comparing pigtail catheters and chest tubes for treating pneumothorax. The letter notes that while drainage success and recurrence were similar, drainage duration was longer for chest tubes. It questions whether this difference reflects hospital practices in removing tubes rather than time to close bronchopleural fistulas. The letter suggests factors like treatment team and physician specialty could influence removal decisions. It concludes pigtail catheters result in less pain and allow alternative placements, making them a reasonable initial treatment option.
This document discusses chest tubes, including their historical development and current uses. It reviews the indications for chest tube placement, such as pneumothoraces, hemothoraces, and pleural effusions following surgery or trauma. Proper training is important to reduce complications. Guidelines are provided for tube placement techniques, maintenance, and discontinuation to safely drain air or fluid from the pleural space.
Emotional and Behavioural Problems in Children - Counselling and Family Thera...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
The Importance of Black Women Understanding the Chemicals in Their Personal C...bkling
Certain chemicals, such as phthalates and parabens, can disrupt the body's hormones and have significant effects on health. According to data, hormone-related health issues such as uterine fibroids, infertility, early puberty and more aggressive forms of breast and endometrial cancers disproportionately affect Black women. Our guest speaker, Jasmine A. McDonald, PhD, an Assistant Professor in the Department of Epidemiology at Columbia University in New York City, discusses the scientific reasons why Black women should pay attention to specific chemicals in their personal care products, like hair care, and ways to minimize their exposure.
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdfVedanta A
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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Sectional dentures for microstomia patients.pptxSatvikaPrasad
Microstomia, characterized by an abnormally small oral aperture, presents significant challenges in prosthodontic treatment, including limited access for examination, difficulties in impression making, and challenges with prosthesis insertion and removal. To manage these issues, customized impression techniques using sectional trays and elastomeric materials are employed. Prostheses may be designed in segments or with flexible materials to facilitate handling. Minimally invasive procedures and the use of digital technologies can enhance patient comfort. Education and training for patients on prosthesis care and maintenance are crucial for compliance. Regular follow-up and a multidisciplinary approach, involving collaboration with other specialists, ensure comprehensive care and improved quality of life for microstomia patients.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
At Malayali Kerala Spa Ajman, Full Service includes individualized care for every client. We specifically design each massage session for the individual needs of the client. Our therapists are always willing to adjust the treatments based on the client's instruction and feedback. This guarantees that every client receives the treatment they expect.
By offering a variety of massage services, our Ajman Spa Massage Center can tackle physical, mental, and emotional illnesses. In addition, efficient identification of specific health conditions and designing treatment plans accordingly can significantly enhance the quality of massaging.
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This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
Get Covid Testing at Fit to Fly PCR TestNX Healthcare
A Fit-to-Fly PCR Test is a crucial service for travelers needing to meet the entry requirements of various countries or airlines. This test involves a polymerase chain reaction (PCR) test for COVID-19, which is considered the gold standard for detecting active infections. At our travel clinic in Leeds, we offer fast and reliable Fit to Fly PCR testing, providing you with an official certificate verifying your negative COVID-19 status. Our process is designed for convenience and accuracy, with quick turnaround times to ensure you receive your results and certificate in time for your departure. Trust our professional and experienced medical team to help you travel safely and compliantly, giving you peace of mind for your journey.www.nxhealthcare.co.uk
nurs fpx 4050 assessment 4 final care coordination plan.pdf
miyazaki2013.pdf
1. ORIGINAL ARTICLE
Chest tube insertion is one important factor leading to intercostal
nerve impairment in thoracic surgery
Takuro Miyazaki • Tetsuya Sakai • Naoya Yamasaki • Tomoshi Tsuchiya •
Keitaro Matsumoto • Tsutomu Tagawa • Go Hatachi • Koichi Tomoshige •
Mariko Mine • Takeshi Nagayasu
Received: 6 August 2013 / Accepted: 24 September 2013 / Published online: 6 October 2013
Ó The Japanese Association for Thoracic Surgery 2013
Abstract
Objectives Chest tube insertion seems to be one impor-
tant factor leading to intercostal nerve impairment. The
purpose of this prospective study was to objectively eval-
uate intercostal nerve damage using current perception
threshold testing in association with chest tube insertion.
Methods Sixteen patients were enrolled in this study.
Intercostal nerve function was assessed with a series of
2000-Hz (Ab fiber), 250-Hz (Ad fiber), and 5-Hz (C fiber)
stimuli using current perception threshold testing (Neu-
rometer CPT/CÒ
). Current perception threshold values at
chest tube insertion were measured before surgery, during
chest tube insertion and after removal of the chest tube.
Intensities of ongoing pain were also assessed using a
numeric rating scale (0–10).
Results Current perception thresholds at each frequency
after surgery were significantly higher than before surgery.
Numeric rating scale scores for pain were significantly
reduced from 3.3 to 1.9 after removal of the chest tube
(p = 0.004). The correlation between current perception
threshold value at 2000 Hz and intensity of ongoing pain
was marginally significant (p = 0.058).
Conclusions This is the first study to objectively evaluate
intercostal nerve damage at chest tube insertion. The
results confirmed that chest tube insertion has clearly del-
eterious effects on intercostal nerve function.
Keywords Pain Lung cancer surgery
Thoracotomy Thoracoscopy/VATS
Introduction
Post-thoracotomy pain syndrome (PTPS) is well estab-
lished as a clinically important entity after thoracotomy,
with persistent pain reported in 30–40 % of patients [1].
PTPS is defined by the International Association for Study
of Pain (IASP) as ‘Pain that recurs or persists along a
thoracotomy scar at least 2 months following a surgical
procedure’ [2]. Many articles have been reported from the
perspective of preoperative factors, intraoperative factors
[3], and anesthetic factors to reduce PTPS. Above all,
video-assisted thoracic surgery (VATS) has been widely
accepted and applied for almost all thoracic surgeries,
given the reduced invasiveness to patients and equivalent
or favourable surgical results compared to conventional
thoracotomy [4]. VATS has thus also been expected to
decrease post-thoracotomy pain.
On the other hand, Kato et al. [5] described a patient
with severe neuropathic pain induced by ligation of an
intercostal nerve after chest tube insertion for secondary
pneumothorax. This was a relatively rare case, but we have
often encountered patients who, even after VATS, suffer
from continuous post-thoracotomy pain around the chest
tube insertion scar. However, most articles have focused
solely on the thoracotomy site. Few reports have examined
the influence of chest tube insertion. Moreover, a key
T. Miyazaki () N. Yamasaki T. Tsuchiya K. Matsumoto
T. Tagawa G. Hatachi K. Tomoshige T. Nagayasu
Division of Surgical Oncology, Nagasaki University
Graduate School of Biomedical Sciences, 1-7-1 Sakamoto,
Nagasaki 852-8501, Japan
e-mail: miyataku@nagasaki-u.ac.jp
T. Sakai
Division of Anesthesiology, Nagasaki University Graduate
School of Biomedical Sciences, Nagasaki, Japan
M. Mine
Division of Scientific Data Registry, Atomic Bomb Disease
Institute, Nagasaki University, Nagasaki, Japan
123
Gen Thorac Cardiovasc Surg (2014) 62:58–63
DOI 10.1007/s11748-013-0328-z
2. problem with researching post-thoracotomy pain has been
the lack of objective tools to measure pain.
We have already evaluated intercostal nerve damage by
current perception threshold (CPT) using the Neurometer
CPT/CÒ
(Neurotron, Baltimore, MD, USA) to objectively
assess nerve function, confirming that VATS is a useful
procedure to reduce PTPS without using metal retractors
that may damage the intercostal nerves [6]. CPT testing can
evaluate sensory nerve fibers quantitatively and selectively.
CPT values with 2000-, 250-, and 5-Hz stimuli indicate the
functions of Ab, Ad, and C fibers, respectively. Ab fibers
are large myelinated fibers responsible for touch and
pressure sensation. Ad fibers are small myelinated fibers
responsible for sharp pain. C fibers are unmyelinated fibers
responsible for sensing temperature and dull pain [7, 8].
The purpose of the present prospective study was to
objectively evaluate intercostal nerve damage associated
with chest tube insertion following lung cancer surgery
using CPT testing. Correlations between CPT values and
intensities of ongoing pain were also assessed.
Patients and methods
Patients
The study was performed at Nagasaki University Hospital
from June 2012 to October 2012. Local ethics committee
approval was obtained prior to commencement of the study
(Approval number: 12052809). All patients provided written
informed consent. A total of 16 patients (7 men, 9 women;
mean age 69.1 years) participated in this study. All patients
had primary lung cancer. Patients who underwent pneumo-
nectomy or chest wall resection, or who had a history of prior
thoracotomy were excluded from this study.
Surgical technique for lung cancer and management
of chest tube
All VATS procedures were performed by visualization
through a television monitor only and the procedure was
performed without metal retractors using the wound
retraction system (WR) (Alexis Wound RetractorÒ
;
Applied Medical, Rancho Santa Margarita, CA, USA),
with an incision length within 4 cm length to remove the
lung from the chest cavity. Standardized three-port place-
ments (ThoracoportÒ
, 11.5 mm; Nippon Covidien, Japan)
were used regardless of the resected lobe and segment.
Once metal retractors were applied, or even if metal
retractors were not used but a skin incision more than 7 cm
was made, the procedure was defined as thoracotomy for
the purposes of this study.
An epidural catheter was placed for each patient and
general anesthesia was induced using propofol and rocu-
ronium. After double lumen endotracheal intubation, the
patient was placed in a lateral position. At first, a 0° tho-
racoscope was introduced through the seventh intercostal
space in the anterior axillary line. Systemic mediastinal or
hilar lymph node dissection was performed according to
clinical stage, performance status, and lymph nodal status
of the patient.
A 24-Fr chest tube [ArgyleÒ
, thoracic catheter, straight,
24-Fr/Ch (8.0 mm) 9 52 cm; Nippon Covidien] was
inserted through the seventh intercostal space where the
port was mainly used as a video camera port in both pro-
cedures. We closed the chest with pericostal sutures (stit-
ches placed on top of the fourth rib and at the bottom of the
fifth rib, to avoid injuring intercostal nerves and vessels).
The chest tube was removed as soon as possible on the
condition that the total amount of pleural effusion was
200 ml/day, no air leakage had been seen for more than
24 h, and no chylothorax was apparent.
Pain relief
For postoperative pain relief, an epidural catheter was
placed according to the site of incision before the induction
of general anesthesia. Ropivacaine (8 mg/h) was given for
no longer than 5 days. The epidural catheter was removed
simultaneously with the chest tube. We did not perform
any intercostal nerve or paravertebral blocks in this study.
All patients received oral celecoxib (200 mg), a systemic,
non-steroidal anti-inflammatory drug, twice a day for at
least 1 week. If the patient was not obtaining good pain
relief, a diclofenac sodium suppository (25 mg) was added.
Current perception threshold and the Neurometer
CPT/CÒ
The Neurometer CPT/CÒ
(Fig. 1) produces constant-cur-
rent sine-wave stimulation at 2000, 250, or 5 Hz. The sine
waves at 2000, 250, and 5 Hz correspond to depolarization
periods of 0.25, 2, and 100 ms, respectively. The electrical
stimulus selectively excites distinct subpopulations of
nerve fibers as a function of the sinusoid frequency [9, 10].
Thus, large myelinated A (Ab), small myelinated A (Ad),
and unmyelinated C(C) nerve fibers are evaluated with a
series of 2000-, 250-, and 5-Hz stimuli, respectively. A pair
of gold-plated surface electrodes was placed just beside the
site of chest tube insertion (Fig. 2). The methods of CPT
testing were similar to those described previously [6, 11,
12].
Patients were also asked to rate the intensity of total
ongoing pain (both at the site of thoracotomy and chest
Gen Thorac Cardiovasc Surg (2014) 62:58–63 59
123
3. tube insertion) using a numerical rating scale (NRS) (0–10,
with 0 = no pain, 10 = worst pain imaginable). Thus,
NRS scores and CPTs were measured before surgery,
during chest tube insertion (just before removal of the chest
tube) and 7 days after surgery. When chest tube placement
was prolonged to more than 7 days, CPT was measured
2 days after chest tube removal.
Statistical analysis
Differences among groups were determined using the
paired t test for continuous variables. CPT data were ana-
lyzed by one-way factorial analysis of variance. A value of
p 0.05 was considered statistically significant. Statistical
analysis was performed using SAS version 9.2 statistical
software (SAS Institute, Cary, NC, USA).
Results
All 16 patients underwent lung resection for clinical stage I
primary lung cancer, with 11 cases of lobectomy, 4 cases of
segmentectomy, and 1 case of partial resection. Fourth
intercostal thoracotomy was performed in 14 cases, and
fifth intercostal thoracotomy in 2 cases. All chest tubes
were inserted through the seventh intercostal space. The
epidural catheter was placed from thoracic vertebral
interspace 6–7 (11 cases) or 7–8 (5 cases) and a catheter
advanced 5 cm into the epidural space. None of the
patients experienced severe operative or postoperative
complications, with the exception of prolonged air leakage
in one patient who had removed the chest tube after post-
operative day 8 and chylothorax in one patient who was
treated using low-fat diet therapy. No drug-related prob-
lems or complications were caused by the analgesic pro-
cedures. No patients dropped out in this study. Patient
demographics and types of surgery are shown in Table 1.
At 2000 Hz (Fig. 3a), CPT values at chest tube insertion
showed a significant increase (p = 0.007) and increased
still further after removal of the chest tube (p = 0.01)
compared to CPT values before surgery. At 250 Hz
(Fig. 3b), CPT values at chest tube insertion showed a
significant increase (p = 0.01). However, CPT values after
removal of the chest tube were marginally decreased
compared to at chest tube insertion (p = 0.05). Similar
results were seen at 5 Hz (Fig. 3c), with CPT values
showing a significant increase at chest tube insertion
(p = 0.002) and decreasing significantly compared to val-
ues at chest tube insertion (p = 0.003).
Mean postoperative pain measured using the NRS
(Fig. 4) was significantly lower (p = 0.004) after removal
of the chest tube than during insertion of the chest tube.
Five of 16 patients (31.3 %) complained of more pain at
the site of chest tube insertion than from thoracotomy. A
marginal correlation was observed between CPT values at
2000 Hz during insertion of the chest tube and after
removal and NRS score (p = 0.058).
Discussion
CPT testing using the Neurometer CPT/CÒ
has now seen
wide use in various clinical setting associated with quanti-
tative evaluation of sensory function, and its utility and
objectivity have been confirmed [13, 14]. However, use of
CPT testing related to thoracic surgery has not been reported
expect in our previous study [6]. We objectively assessed
intercostal nerve damage by chest tube insertion in lung
cancer surgery using CPT testing, because we have
encountered some patients who complain of persisting pain
around the site of chest tube insertion despite the use of
Fig. 1 Neurometer CPT/CÒ
for measurement of current perception
threshold (CPT) values
Fig. 2 The experiments were carried out with patients in a supine
position in an isolated room. A pair of gold-plated surface electrodes
was placed just beside the site of chest tube insertion
60 Gen Thorac Cardiovasc Surg (2014) 62:58–63
123
4. VATS. Intercostal nerve damage is well known as a main
cause of post-thoracotomy pain. We have previously eval-
uated intercostal nerve damage by CPT with the Neurometer
CPT/CÒ
, to objectively assess intercostal nerve function and
offer the first confirmation that VATS is useful for reducing
PTPS [6]. The present study demonstrated that chest tube
insertion is also clearly harmful to the intercostal nerves and
could result in post-thoracotomy pain.
We have shown in this study that the function of mye-
linated fibers (Ab and Ad fibers) in the intercostal nerve is
significantly impaired after insertion of the chest tube.
Continuous compression of intercostal nerves by the chest
tube is also responsible for elevated CPT values, as pre-
viously shown with metal retractors during surgery [6]. We
also confirmed that myelinated fibers are sensitive to
mechanical compression. On the other hand, unmyelinated
C fibers were also seen to be significantly impaired after
Table 1 Patients characteristics
Number of patients 16
Age (years) 70 (54–83)a
Gender
Male 7
Female 9
Methods
VATS 5
Thoracotomy 11
Length of skin incision (cm) 8 (4–12)a
Surgery time (min) 249 (74–349)a
Chest tube insertion (days) 3.8 (2–8)a
Procedure
Lobotomy 11
Segmentectomy 4
Partial resection 1
Clinical stage
IA 13
IB 3
Resected lobe
Right upper 3
Middle 3
Lower 3
Left upper 3
Lower 4
Lymphnode dissection
ND2 11
ND1 4
ND0 1
VATS video-assisted thoracic surgery, ND nodal dissection
a
Median (minimum–maximum)
0
50
100
150
200
250
Before Insertion After
* **
p = 0.007 p = 0.01
CPT
values
2000 Hz
0
20
40
60
80
100
Before Insertion After
*
p = 0.01
CPT
values
250 Hz
0
20
40
60
80
100
Before Insertion After
p = 0.002
*
CPT
values
5 Hz
A
B
C
Fig. 3 The transition of CPT values at 2000 (a), 250 (b), and 5 (c) Hz
in the intercostal nerve associated with the influence of chest tube
insertion. a CPT values at 2000 Hz during insertion and after removal
of the chest tube were significantly higher than before surgery
(p = 0.007, 0.01, respectively). b CPT values at 250 Hz were
significantly higher during insertion than before surgery (p = 0.01).
CPT values after removal of the chest tube were not significantly
decreased compared to CPT values at chest tube insertion (p = 0.05).
c CPT values at 5 Hz during insertion were significantly higher than
before surgery (p = 0.002). CPT values after removal of the chest
tube were significantly decreased compared to CPT values at chest
tube insertion (p = 0.003). CPT current perception threshold, Before
before surgery, Insertion during insertion of the chest tube, After after
chest tube removal
Gen Thorac Cardiovasc Surg (2014) 62:58–63 61
123
5. insertion of the chest tube in this study, even though C
fibers were not impaired by metal retractors [6]. Han and
Ha [14] reported that the degeneration of Ab and Ad fibers
was more rapid than that of C fibers in patients with dia-
betic neuropathy. Given these results, C fibers (unmyeli-
nated fibers) seem stronger than Ab and Ad fibers
(myelinated fibers) in terms of resisting physical stimuli.
We do not have a definite cause for this result, but we
speculated that continuous chest tube insertion for
3.8 days, as the average duration of chest tube insertion in
this study, caused more intercostal nerve damage than use
of metal retractors during several hours of lung surgery.
In the present study, the NRS scores decreased signifi-
cantly after chest tube removal, although this decrease could
represent the natural course of wound healing. As we have
experienced in daily practice, five of 16 patients (31.3 %)
complained of more pain at the site of chest tube insertion
than at the thoracotomy site. Moreover, two of those five
patients (40.0 %) had undergone VATS. Surgeons should
thus recognize that chest tube insertion could result in more
intercostal nerve damage than thoracotomy itself.
We found a marginally significant correlation between
CPT values at 2000 Hz during insertion of the chest tube
and after removal and NRS. The present results implied
that CPT values may be useful for evaluating the intensity
of ongoing pain despite surgical procedure, race, age, sex
and other factors considered to impact postoperative pain.
However, this test did not always correlate with clinical
symptoms of pain, because neuropathic pain has been
reported to involve both peripheral and central mecha-
nisms. We have previously reported on allodynia and pain
of postherpetic neuralgia using CPT and found no corre-
lation between intensities of ongoing pain and CPT values
at any frequencies, proposing that postherpetic neuralgia
might be a pain syndrome including both peripheral and
central mechanisms [11].
Wildgaard et al. [15] evaluated neurophysiological
characterization of PTPS after VATS by using quantitative
sensory testing, using thermal and mechanical stimuli. In
that study, both PTPS and pain-free patients showed
increased sensory thresholds implying the existence of
nerve injury, but no significant quantitative differences
between PTPS and pain-free patients could be found. These
findings suggested that the presence of factors other than
intercostal nerve injury was important for PTPS after
VATS lobectomy. That report indicated that the cause of
neuropathic pain is not simply damage to a single nerve,
but involves multi-factorial mechanisms. For example,
pregabalin, a derivative of c-aminobutyric acid, is a drug
that binds to Ca2?
channels in the nerve presynapes and
suppresses release of neural transmitters, thus showing
analgesic effects for neuropathic pain [16]. For this reason,
pregabalin has now gained wide use for neuropathic pain,
including post-thoracotomy pain. Matsunami and Ka-
wamura [17] reported on four patients who showed sig-
nificant improvement of chronic pain after thoracotomy
with pregabalin administration.
Moreover, several genetic approaches have attempted to
identify the intensity of postoperative pain. Lee et al. [18]
reported that catecholamine-O-methyltransferase poly-
morphisms are associated with postoperative pain intensity
after elective surgery. Moreover, Ochroch et al. [19]
identified haplotypes of the l-opioid receptor (OPMR1)
that predicted increases in self-reported pain on postoper-
ative day 3 after thoracotomy. We hope that the detailed
mechanisms underlying post-thoracotomy pain will be
resolved in the near future and ‘tailor-made’ pain control
will move a step closer.
However, it is realistic for surgeons to find other
effective methods to reduce intercostal nerve damage by
chest tube insertion in daily life. As recently developed
silastic flexible drains, BlakeÒ
drains (Ethicon, Somerville,
NJ, USA) are available and expected to address the dis-
advantage of conventional drains in terms of rigidity and
thickness. Nakamura et al. [20] have used these new drains
in 420 cases of thoracic surgery. The drains functioned
efficiently even under situations of postoperative bleeding,
prolonged air leakage, and chylothorax. Moreover, the
most important point in that study was that no patients
complained of discomfort resulting from drain placement.
They concluded that Blake drains represent an acceptable
option for general thoracic surgery. Thus, it may be
worthwhile to assess intercostal nerve damage using thin-
ner, softer drains, such as the Blake drain, using CPT
testing. Use of such drains could alleviate pain around the
site of chest tube insertion. However, Clark et al. [21]
reported encountering life-threatening hypovolemic shock
in patients after thoracic surgery associated with non-
functioning small-sized silastic drains. Moreover, we have
Fig. 4 NRS after removal of the chest tube was significantly lower
than that during chest tube insertion (p = 0.004). NRS numeric rating
scale, Insertion during insertion chest tube, After after chest tube
removal
62 Gen Thorac Cardiovasc Surg (2014) 62:58–63
123
6. experienced several clinical cases of severe subcutaneous
emphysema with Blake drains that did not appropriately
drain the air from the chest cavity, especially in patients
with severe emphysematous lung. Sakakura et al. [22]
reported not only on the efficiency of Blake drains, but also
on their disadvantages. In that study, insufficient air
evacuation was seen in some cases compared to conven-
tional drains and suction was considered warranted when
air leakage occurred. Although we sometimes use it in
partial resection of primary or metastatic lung cancers,
mediastinal tumors, or spontaneous pneumothorax, we do
not always use suction in lung cancer surgery.
This present study had three main limitations. First, the
sample population was very small and obtained from a
single institution. Small samples sometimes affect the
statistical accuracy. Second, the site of chest tube insertion
was also used as a video camera port, where the scope was
usually heavily manipulated during surgical procedures.
We thus cannot exclude the possibility of effects on
physical oppression. Third, we cannot discriminate the
pure intercostal nerve damage with chest tube insertion
from the retractor’s damage itself, because we included
both VATS and thoracotomy approaches. Future studies
are needed to address these limitations.
Conclusion
This represents the first report to assess intercostal nerve
damage after chest tube insertion during lung cancer sur-
gery using CPT testing. The present study demonstrated
that chest tube insertion has negative effects on the inter-
costal nerve, as seen for metal retractors during thoracot-
omy. Attention needs to be paid not only to the
thoracotomy wound, but also to the chest tube in reducing
pain.
Conflict of interest Miyazaki and other co-authors have no conflict
of interest.
References
1. Wildgaard K, Ravn J, Kehlet H. Chronic post-thoracotomy
pain—a critical review of pathogenic mechanisms and strategies
for prevention. Eur J Cardiothorac Surg. 2009;36:170–80.
2. Merskey H, Bogduk H. Classification of chronic pain. In: Mers-
key H, Bogduk H, editors. Descriptions of chronic pain syn-
dromes and definitions of pain terms. 2nd ed. Seattle: ISAP Press;
1994. p. 143–4.
3. Helms O, Mariano J, Hentz JG, Santelmo N, Falcoz PE, Massard G,
et al. Intra-operative paravertebral block for postoperative anal-
gesia in thoracotomy patients: a randomized, double-blind, pla-
cebo-controlled study. Eur J Cardiothorac Surg. 2011;40:902–6.
4. Cajipe MD, Chu D, Bakaeen FG, Casal RF, Lemaire SA, Coselli
JS, et al. Video-assisted thoracoscopic lobectomy is associated
with better perioperative outcomes than open lobectomy in a
veteran population. Am J Surg. 2012;204:607–12.
5. Kato J, Gokan D, Hirose N, Baba M, Ehara T, Ogawa S. Clinical
course of pain in a patent with neuropathic pain induced by
ligation of an intercostal nerve. J Clin Anesth. 2010;22:50–1.
6. Miyazaki T, Sakai T, Tsuchiya T, Yamasaki N, Tagawa T, Mine
M, et al. Assessment and follow-up of intercostal nerve damage
after video-assisted thoracic surgery. Eur J Cardiothorac Surg.
2011;39:1033–9.
7. Masson EA, Boulton AJM. The neurometer: validation and
comparison with conventional tests for diabetic neuropathy.
Diabet Med. 1991;8:563–6.
8. Masson EA, Veses A, Fernando D, Boulton AJM. Current per-
ception threshold: a new, quick, and reproducible method for
assessment of peripheral neuropathy in diabetes mellitus. Dia-
betology. 1989;32:724–8.
9. Katims JJ, Naviasky EH, Ng LK, Rendell M, Bleecker ML. New
screening device for assessment of peripheral neuropathy.
J Occup Med. 1986;28:1219–21.
10. Katims JJ, Naviasky EH, Rendell MS, Ng LK, Bleecker ML.
Constant current sine wave transcutaneous nerve stimulation for
the evaluation of peripheral neuropathy. Arch Phys Med Rehabil.
1987;68:210–3.
11. Sakai T, Tomiyasu S, Yamada H, Sumikawa K. Evaluation of
allodynia and pain associated with postherpetic neuralgia using
current perception threshold testing. Clin J Pain. 2006;22:359–62.
12. Sakai T, Aoki H, Hojo M, Takada M, Murata H, Sumikawa K.
Adhesiolysis and targeted steroid/local anesthetic injection during
epiduroscopy alleviates pain and reduces sensory nerve dys-
function in patients with chronic sciatica. J Anesth.
2008;22:242–7.
13. Fujihara A, Ukimura O, Iwata T, Miki T. Neuroselective measure
of the current perception threshold of A-delta and C-fiber affer-
ents in the lower urinary tract. Int J Urol. 2011;18:341–9.
14. Han D, Ha M. The usefulness of current perception threshold test
in both lower extremities with diabetic patient. J Phys Ther Sci.
2011;23:13–5.
15. Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Werner
MU, Kehlet H. Quantitative sensory testing of persistent pain
after video-assisted thoracic surgery lobectomy. Br J Anaesth.
2012;108:126–33.
16. Dooley DJ, Donovan CM, Meder WP, Whetzel SZ. Preferential
action of gabapentin and pregabalin at P/Q-type voltage-sensitive
calcium channels: inhibition of K?-evoked [3H]-norepinephrine
release from rat neocortical slices. Synapse. 2002;45:171–90.
17. Matsunami N, Kawamura M. Significant improvement of chronic
pain by pregabalin after thoracotomy: report of four cases. Surg
Today. 2013;43:915–17.
18. Lee PJ, Delaney P, Keogh J, Sleeman D, Shorten GD. Cate-
cholamine-O-methyltransferase polymorphisms are associated
with postoperative pain intensity. Clin J Pain. 2011;27:93–101.
19. Ochroch EA, Vachani A, Gottschalk A, Kanetsky PA. Natural
variation in the l-opioid gene OPRM1 predicts increased pain on
third day after thoracotomy. Clin J Pain. 2012;28:747–54.
20. Nakamura H, Taniguchi Y, Miwa K, Adachi Y, Fujioka S, Haruki
T. The use of Blake drains following general thoracic surgery: is
it an acceptable option? Interact CardioVasc Thorac Surg.
2009;8:58–61.
21. Clark G, Licker M, Bertin D, Spiliopoulos A. Small size new
silastic drains: life-threatening hypovolemic shock after thoracic
surgery associated with a non-functioning chest tube. Eur J
Cardiothorac Surg. 2007;31:566–8.
22. Sakakura N, Fukui T, Mori S, Hatooka S, Yokoi K, Mitsudomi T.
Fluid drainage and air evacuation characteristics of Blake and
conventional drains used after pulmonary resection. Ann Thorac
Surg. 2009;87:1539–45.
Gen Thorac Cardiovasc Surg (2014) 62:58–63 63
123