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B404 Interventional treatment of chronic pain in patient after thoracotomy approach case report
  1. A Dimitrovski1,
  2. M Toleska Doneska1,
  3. B Kuzmanovska1,
  4. N Toleska Dimitrovska2,
  5. A Trajanovski3,
  6. M Mojsova Mijovska1 and
  7. F Naumovski1
  1. 1Ss.Cyril and Methodius Univesiry – Skopje/TOARILUC – KARIL, Skopje, North Macedonia, The Republic of
  2. 2Ss.Cyril and Methodius Univesiry – Skopje/UK for Thorcacic and vascular surery, Skopje, North Macedonia, The Republic of
  3. 3Ss.Cyril and Methodius Univesiry – Skopje/TOARILUC, Skopje, North Macedonia, The Republic of


Background and Aims Open thoracotomy is accompanied by severe postoperative pain. In 5–65% of patients who undergo rib retraction during surgery there is intercostal nerve damage, which will lead to chronic intercostal pain1,2.

Ultrasound guided ntercostal block is an effective method of interventional treatment of this type of pain.3

Methods We will describe a case of a 56-year-old patient who underwent open thoracotomy 4 years ago due to surgical treatment of lung cancer. Postoperatively, the patient had chemotherapy and radiotherapy. Also, postoperatively, intercostal pain occured at the site of thoracotomy, which extended to the anterior thoracic wall and mamilla of the mammary gland. The patient described the pain as severe burning. He was initially treated by an oncologist with non-steroid anti-inflammatory drugs, opiates but the pain only subsided, never disappeared. Methadone tolerance developed which the patient has been taking in drops for 4 years and the patient was extremely incapable of performing everyday activities.During ultrasound examination we found that there was a significant narrowing of the intercostal space at the site and level of thoracotomy (Figure 1 and 2). We performed ultrasound guided intercostal block and applied 5 ml of bupivacaine 0.5% and 4 mg of dexamethasone. (Figure 3)

Results Within 15 minutes after performing the block, the patient‘s pain completely subsided. The patient was followed for a period of 30 days, he reported no pain and subsequently did not use analgesics at all.

Conclusions Ultrasound-guided intercostal block applied with a small volume of local anesthetic and corticosteroid is an effective treatment for chronic intercostal pain.

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