Chest tube insertion is one important factor leading to intercostal nerve impairment in thoracic surgery

Objectives: Chest tube insertion seems to be one important factor leading to intercostal nerve impairment. The purpose of this prospective study was to objectively evaluate intercostal nerve damage using current perception threshold testing in association with chest tube insertion. Methods: Sixteen patients were enrolled in this study. Intercostal nerve function was assessed with a series of 2000-Hz (Aβ fiber), 250-Hz (Aδ fiber), and 5-Hz (C fiber) stimuli using current perception threshold testing (Neurometer CPT/C R). Current perception threshold values at chest tube insertion were measured before surgery, during chest tube insertion and after removal of the chest tube. Intensities of ongoing pain were also assessed using a numeric rating scale (0-10). Results: Current perception thresholds at each frequency after surgery were significantly higher than before surgery. Numeric rating scale scores for pain were significantly reduced from 3.3 to 1.9 after removal of the chest tube (p = 0.004). The correlation between current perception threshold value at 2000 Hz and intensity of ongoing pain was marginally significant (p = 0.058). Conclusions: This is the first study to objectively evaluate intercostal nerve damage at chest tube insertion. The results confirmed that chest tube insertion has clearly deleterious effects on intercostal nerve function

An electronic-engineered sensory sternal retractor aimed at post-sternotomy pain reduction

none6noThe median sternotomy can rise in rib and/or sternum micro/macro-fractures and/or brachial plexus injuries, which can even evolve in chronic pain with significant impact on patient’s quality life. Post-sternotomy chronic pain is recognized as a multifactorial complex issue, and it has been assessed that sternum retraction forces, applied by the surgeons, can be considered one of these factors. In order to investigate the behavior of these forces, we developed a reliable and sterilizable system, to monitor the retraction forces along the hemisternums. Therefore, a Finochietto sternal retractor was instrumented by means of ultra-thin force sensors interfaced with ad hoc electronic circuitry. Two different sets of sensors were adopted, one of which able to support autoclave operating conditions. In-vitro tests were performed by means of a made on purpose dummy. The instrumented retractor allows monitoring the force exerted on both the arms during the opening procedure. Force versus time patterns were acquired and stored, and so we determined how the forces are distributed in terms of their mean, maximum and plateaus. Results demonstrate the reliability of the instrumented retractor in measuring forces, up to 400 N. Cost-effectiveness and feasibility can be considered further additional values of the proposed instrumented retractor.noneSaggio G.; Bianco A.; Orengo G.; Tancredi G.; Del Gaudio C.; Zeitani J.Saggio, G.; Bianco, A.; Orengo, G.; Tancredi, G.; Del Gaudio, C.; Zeitani, J