Pj. Guelinckx et al., INTERCOSTAL NERVE LOOP AS AN ORIGINAL TREATMENT FOR LONG-TERM POSTTHORACOTOMY PAIN, European journal of plastic surgery, 21(3), 1998, pp. 139-145
Up to now, the treatment for long-term postthoracotomy pain has been p
roblematic. Conservative methods, surgical, or percutaneous rhizotomie
s or implantation of a permanent nerve stimulator have failed in many
patients, and were not without risk. Because of this, we looked for a
fundamental physiologically based approach to manage this pain problem
with minimal risks but long lasting effect. As most patients obtained
complete temporary pain relief after an intercostal nerve block of se
rial dermatomes bordering the thoracotomy, nerve ischemia, nerve entra
pment in scar tissue, nerve compression due to abnormal bone formation
and neuroma function may all have been mechanisms resulting in pain.
Subsequently, three intercostal nerve loops between the six intercosta
l nerves, belonging to the three ribs above and below the thoracotomy,
were performed. This technique creates permanent anesthetic dermatome
s, thus avoiding nociceptive afferent stimuli and preventing recurrenc
e of aberrant nerve regeneration responsible for chronic pain. This te
chnique was applied successfully in five cases with a mean follow-up o
f 13 months. As nerve regeneration has stopped at that time, neuroma f
ormation is prevented and pain recurrence is not to be expected. We, t
herefore, propose that if an anatomical pain distribution pattern alon
g the thoracotomy scar is found in patients with long-term post-thorac
otomy pain, serial intercostal nerve loops might be indicated as prima
ry treatment.