Instead of crushing the intercostal muscle and nerve that lies between the ribs during rib spreading when performing a lung resection, Robert J. Cerfolio, MD, University of Alabama at Birmingham, Birmingham, Alabama, teases the muscle and nerve away from the rib and then moves it out of the way before spreading the ribs. This leads to less trauma to the muscle and intercostal nerve and dramatically reduces postoperative pain.

This new technique is a further modification of a concept that Dr. Cerfolio and colleagues reported in 2005. In this new modification, the muscle is no longer divided but is allowed to dangle under the rib spreader, further avoiding trauma to the nerve and muscle.

For the 160 patients participating in this study, those who received the modified muscle flap technique reported that pain was reduced both in the hospital and after surgery at weeks 3, 4, 8, and 12. Those who received the modified muscle flap procedure had lower pain scores and required less pain medications than those who did not. They also were more likely to return to normal activities within 8 to 12 weeks after the surgery.

The study used sophisticated, objective measurements of pain, including multiple pain score surveys, and measurements of patients' pain medication usage.

SOURCE: University of Alabama at Birmingham

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