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Ann Thorac Surg 1997;64:207-210
© 1997 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Postoperative Pain and Superficial Abdominal Reflexes After Posterolateral Thoracotomy

Department of Neuroscience, CIND Center for the Neurophysiology of Pain, and Department of Thoracic Surgery, University of Torino Medical School, Torino, Italy

Accepted for publication January 15, 1997.

Background. Posterolateral thoracotomy can produce stretching of/or damage to the intercostal nerves and their branches. To assess intercostal nerve impairment after operation, we measured the superficial abdominal reflexes, which are mediated, at least in part, by the most inferior intercostal nerves.

Methods. Using electrophysiologic techniques, we made recordings from the left and right abdominal walls to study the responses evoked by mechanical stimulation of the skin after operation. In addition, we assessed postoperative pain intensity according to a numeric rating scale and recorded postoperative opioid dose.

Results. We found that the patients with complete disappearance of the superficial abdominal reflexes experienced more severe postoperative pain than those in whom the reflexes were maintained. Moreover, opioid treatment was less effective in the patients with no reflexes postoperatively.

Conclusions. Our findings show a strict correlation between pain intensity after posterolateral thoracotomy and absence of abdominal reflexes. We suggest that the higher pain intensity together with the absence of reflexes may be due to intercostal nerve impairment, be it anatomic or functional, and thus to a larger neuropathic component of postoperative pain. This finding may be used as a predictor of patients with high analgesic requirements.

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