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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 394-400, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
SR Hazelrigg, RJ Landreneau, TM Boley, M Priesmeyer, RA Schmaltz, W Nawarawong, JA Johnson, JT Walls and JJ Curtis
Increased interest in alternative approaches to thoracotomy has developed
because of the considerable morbidity associated with the standard
posterolateral technique. We conducted a prospective, randomized, blinded
study of 50 consecutive patients to compare postoperative pain, pulmonary
function, shoulder strength, and range of shoulder motion between the
standard posterolateral and the muscle sparing thoracotomy techniques.
Pulmonary function (forced expiratory volume in 1 second and forced vital
capacity), shoulder strength, and range of motion were measured
preoperatively and at 1 week and 1 month postoperatively. Pain was
quantitated by postoperative narcotic requirements, the visual analogue
scale, and the McGill pain questionnaire. Morbidity, mortality, and
hospital stay were compared between the standard posterolateral and
muscle-sparing techniques. There were no differences in postoperative
pulmonary function, shoulder range of motion, extent of lung resection,
surgical approach time, mortality, or hospital stay. There was
significantly less postoperative pain in the muscle-sparing group. The
narcotic requirement was less in the first 24 hours (p = 0.0169), and
visual analogue scale scores were significantly lower (p less than 0.05)
throughout the first postoperative week. Shoulder girdle strength was
decreased at 1 week in the standard incision group whereas the strength was
preserved with the muscle-sparing approach. Muscle strength had returned to
preoperative levels by 1 month in both groups. Morbidity was identical in
the two groups with the exception of postoperative seromas. The prevalence
of seroma was 23% in the muscle-sparing group and 0% in the standard
incision group (p = 0.0125). We have demonstrated that the muscle- sparing
incision may be a reasonable alternative to the standard posterolateral
approach.
ARTICLES
The effect of muscle-sparing versus standard posterolateral thoracotomy on pulmonary function, muscle strength, and postoperative pain
University of Missouri Health Science Center, Columbia 65212.
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