Pericostal Suturing of The Ribs in Closure of Thoracotomy versus Intracostal Nerve Sparing Closure

Ibrahim, Amr El Sayed Tawfek; Lasheen, Ahmed Mohsen Helmy Hassan; Mobasher, Magdy Kamal Morsy; Ebrahim, Osama Saber Abdelalem; Elawady, Tamer Salem Mohamed

doi:10.21608/zumj.2025.390394.3977

Pericostal Suturing of The Ribs in Closure of Thoracotomy versus Intracostal Nerve Sparing Closure

Document Type : Original Article

Authors

¹ Assistant Professor of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University

² Resident of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University

³ Professor of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University

10.21608/zumj.2025.390394.3977

Abstract

Background: Post-thoracotomy pain is a common and significant complication following open chest surgery. Convential pericostal suturing has been the standard closure technique, but it may exacerbate nerve compression. An alternative method, intracostal suturing, aims to spare the subcostal nerve bundle and potentially reduce postoperative pain. This study aimed to evaluate the effectiveness of intracostal (nerve-sparing) sutures compared to standard pericostal sutures in reducing postoperative pain following thoracotomy.

Methods: A prospective randomized clinical trial was conducted on 74 patients undergoing thoracotomy at Zagazig University Hospitals between August 2023 and August 2024. Patients were randomized into two groups: Group I (pericostal sutures, n=37) and Group II (intracostal sutures, n=37). Postoperative outcomes assessed included pain intensity using the Numerical Rating Scale (NRS), need for opioid analgesia, duration of chest tube drainage, length of hospital stay, pulmonary function tests, and postoperative complications.

Results: Patients in the intracostal group exhibited significantly lower postoperative pain scores at multiple time points (2 hours, 1st day, 2nd day, and 1 month postoperative; p<0.05). They also demonstrated a reduced need for opioid analgesia compared to the pericostal group (p<0.05). No significant differences were observed between the groups regarding chest tube drainage duration, hospital stay, pulmonary function outcomes, or complication rates.

Conclusion: Intracostal suturing in thoracotomy closure significantly reduces postoperative pain and analgesic requirements without increasing complication rates, offering a superior alternative to traditional pericostal suturing techniques for improving patient outcomes.

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