Stripping Massage and Literature Review in Post-Thoracoscopic Chest Pain Management

 

 Buy Article Permissions and Reprints All articles of this category

Abstract

The aim of this randomized study was to investigate whether stripping massage (SM) of myofascial trigger points in the lower rhomboid muscle could alleviate chest pain in patients following thoracoscopic surgery. In addition, a literature review was conducted to assess the effectiveness of various pain management techniques. Sixty adult patients who reported a visual analog scale (VAS) score of 4 or higher were randomly assigned to receive conventional analgesics alone (conventional group) or combined with SM twice daily for 2 weeks (SM group). VAS scores and the use of additional analgesics were evaluated on postoperative days 1, 3, 7, 14, and 30. Using the PubMed and Cochrane Library databases, a review of current pain management techniques was carried out up to January 31, 2022. A subgroup analysis was also performed to examine the treatment effect during different surgical periods and techniques. Results showed that the SM group had significantly lower VAS scores on postoperative days 3, 7, 14, and 30 (p < 0.001), as well as a shorter hospitalization duration and reduced need for additional analgesics (p < 0.001). The literature review included a total of 20 studies (2,342 cases of chest pain relief after thoracoscopic surgery), which indicated that serratus anterior plane (SAP) blocks were commonly used as a perioperative approach to reduce pain and opioid consumption. SM and SAP can both serve as adjuvant treatments for chest pain in patients following thoracoscopic surgery, with SM being a safe and noninvasive pain control option after hospital discharge.

Publication History

Received: 22 April 2023

Accepted: 24 July 2023

Accepted Manuscript online:
25 July 2023

Article published online:
23 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

• References

• 1 Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 2016; 17 (06) 836-844
  CrossrefPubMedGoogle Scholar
• 2 Tan HS, Habib AS. Safety evaluation of oliceridine for the management of postoperative moderate-to-severe acute pain. Expert Opin Drug Saf 2021; 20 (11) 1291-1298
  CrossrefPubMedGoogle Scholar
• 3 Heneghan NR, Smith R, Tyros I, Falla D, Rushton A. Thoracic dysfunction in whiplash associated disorders: a systematic review. PLoS One 2018; 13 (03) e0194235
  CrossrefPubMedGoogle Scholar
• 4 Domingo AR, Diek M, Goble KM, Maluf KS, Goble DJ, Baweja HS. Short-duration therapeutic massage reduces postural upper trapezius muscle activity. Neuroreport 2017; 28 (02) 108-110
  CrossrefPubMedGoogle Scholar
• 5 Shah JP, Thaker N, Heimur J, Aredo JV, Sikdar S, Gerber L. Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015; 7 (07) 746-761
  CrossrefPubMedGoogle Scholar
• 6 Koren Y, Kalichman L. Deep tissue massage: what are we talking about?. J Bodyw Mov Ther 2018; 22 (02) 247-251
  CrossrefPubMedGoogle Scholar
• 7 Zengin M, Sazak H, Baldemir R. et al. Parameters affecting nausea and vomiting after thoracoscopic wedge resection in patients with pneumothorax. Cureus 2021; 13 (11) e19926
  PubMedGoogle Scholar
• 8 Zengin M, Ulger G, Baldemir R, Sazak H, Alagoz A. Is there a relationship between body mass index and postoperative pain scores in thoracotomy patients with thoracic epidural analgesia?. Medicine (Baltimore) 2021; 100 (50) e28010
  CrossrefPubMedGoogle Scholar
• 9 Keijzer S, Oosterhuis W, Hazelbag HM, Meuleman T. Pathological diagnosis of thoracic endometriosis. BMJ Case Rep 2021; 14 (08) e243258
  CrossrefPubMedGoogle Scholar
• 10 Paul S, Altorki NK, Sheng S. et al. Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. J Thorac Cardiovasc Surg 2010; 139 (02) 366-378
  CrossrefPubMedGoogle Scholar
• 11 Lavelle ED, Lavelle W, Smith HS. Myofascial trigger points. Anesthesiol Clin 2007; 25 (04) 841-851 , vii–iii
  CrossrefPubMedGoogle Scholar
• 12 Fryer G, Hodgson L. The effect of manual pressure release on myofascial trigger points in the upper trapezius muscle. J Bodyw Mov Ther 2005; 9 (04) 248-255
  CrossrefPubMedGoogle Scholar
• 13 Ohmori A, Iranami H, Fujii K, Yamazaki A, Doko Y. Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery. J Cardiothorac Vasc Anesth 2013; 27 (06) 1310-1314
  CrossrefPubMedGoogle Scholar
• 14 Huguenin LK. Myofascial trigger points: the current evidence. Phys Ther Sport 2004; 5 (01) 2-12
  CrossrefPubMedGoogle Scholar
• 15 Majlesi J, Ünalan H. High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Arch Phys Med Rehabil 2004; 85 (05) 833-836
  CrossrefPubMedGoogle Scholar
• 16 Majlesi J, Unalan H. Effect of treatment on trigger points. Curr Pain Headache Rep 2010; 14 (05) 353-360
  CrossrefPubMedGoogle Scholar
• 17 Elsharkawy H, Maniker R, Bolash R, Kalasbail P, Drake RL, Elkassabany N. Rhomboid intercostal and subserratus plane block: a cadaveric and clinical evaluation. Reg Anesth Pain Med 2018; 43 (07) 745-751
  PubMedGoogle Scholar
• 18 Longo F, Piliego C, Martuscelli M. et al. Rhomboid intercostal and subserratus plane block for intubated uniportal video-assisted thoracoscopic surgery lobectomy. J Clin Anesth 2020; 65: 109881
  CrossrefPubMedGoogle Scholar
• 19 Borg-Stein J. Treatment of fibromyalgia, myofascial pain, and related disorders. Phys Med Rehabil Clin N Am 2006; 17 (02) 491-510 , viii
  CrossrefPubMedGoogle Scholar
• 20 Okamoto T, Masuhara M, Ikuta K. Acute effects of self-myofascial release using a foam roller on arterial function. J Strength Cond Res 2014; 28 (01) 69-73
  CrossrefPubMedGoogle Scholar
• 21 Weerapong P, Hume PA, Kolt GS. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 2005; 35 (03) 235-256
  CrossrefPubMedGoogle Scholar
• 22 Weerapong P, Hume PA, Kolt GS. Stretching: mechanisms and benefits for sport performance and injury prevention. Phys Ther Rev 2004; 9 (04) 189-206
  CrossrefPubMedGoogle Scholar
• 23 Qiu Y, Wu J, Huang Q. et al. Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery: a noninferiority randomised trial. Eur J Anaesthesiol 2021; 38 (Suppl. 02) S97-S105
  CrossrefPubMedGoogle Scholar
• 24 Dikici M, Akesen S, Yavaşcaoğlu B, Bayram AS, Kaya FN, Gurbet A. Comparison of intraoperative and post-operative effects of serratus anterior plane block performed with ultrasound and infiltration block in patients undergoing video-assisted thoracoscopic surgery. Agri 2022; 34 (01) 23-32
  PubMedGoogle Scholar
• 25 Li Q, Yao H, Xu M, Wu J. Dexmedetomidine combined with sufentanil and dezocine-based patient-controlled intravenous analgesia increases female patients' global satisfaction degree after thoracoscopic surgery. J Cardiothorac Surg 2021; 16 (01) 102-108
  CrossrefPubMedGoogle Scholar
• 26 Kimura Kuroiwa K, Shiko Y, Kawasaki Y. et al. Phrenic nerve block at the azygos vein level versus sham block for ipsilateral shoulder pain after video-assisted thoracoscopic surgery: a randomized controlled trial. Anesth Analg 2021; 132 (06) 1594-1602
  CrossrefPubMedGoogle Scholar
• 27 Moon DH, Park J, Kang DY, Lee HS, Lee S. Intramuscular stimulation as a novel alternative method of pain management after thoracic surgery. J Thorac Dis 2019; 11 (04) 1528-1535
  CrossrefPubMedGoogle Scholar
• 28 Freise H, Van Aken HK. Risks and benefits of thoracic epidural anaesthesia. Br J Anaesth 2011; 107 (06) 859-868
  CrossrefPubMedGoogle Scholar
• 29 Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin 2008; 26 (02) 355-367 , vii
  CrossrefPubMedGoogle Scholar
• 30 Zhang X, Zhang C, Zhou X. et al. Analgesic effectiveness of perioperative ultrasound-guided serratus anterior plane block combined with general anesthesia in patients undergoing video-assisted thoracoscopic surgery: a systematic review and meta-analysis. Pain Med 2020; 21 (10) 2412-2422
  CrossrefPubMedGoogle Scholar
• 31 Luo G, Zhu J, Ni H. et al. Pretreatment with pectoral nerve block ii is effective for reducing pain in patients undergoing thoracoscopic lobectomy: a randomized, double-blind, placebo-controlled trial. BioMed Res Int 2021; 2021: 6693221
  PubMedGoogle Scholar
• 32 Kim S, Bae CM, Do YW, Moon S, Baek SI, Lee DH. Serratus anterior plane block and intercostal nerve block after thoracoscopic surgery. Thorac Cardiovasc Surg 2021; 69 (06) 564-569
  Article in Thieme ConnectPubMedGoogle Scholar
• 33 Park MH, Kim JA, Ahn HJ, Yang MK, Son HJ, Seong BG. A randomised trial of serratus anterior plane block for analgesia after thoracoscopic surgery. Anaesthesia 2018; 73 (10) 1260-1264
  CrossrefPubMedGoogle Scholar
• 34 Yang HC, Lee JY, Ahn S. et al. Pain control of thoracoscopic major pulmonary resection: is pre-emptive local bupivacaine injection able to replace the intravenous patient controlled analgesia?. J Thorac Dis 2015; 7 (11) 1960-1969
  PubMedGoogle Scholar
• 35 Demmy TL, Nwogu C, Solan P, Yendamuri S, Wilding G, DeLeon O. Chest tube-delivered bupivacaine improves pain and decreases opioid use after thoracoscopy. Ann Thorac Surg 2009; 87 (04) 1040-1046 , discussion 1046–1047
  CrossrefPubMedGoogle Scholar
• 36 Qiu Y, Wu J, Huang Q. et al. Acute pain after serratus anterior plane or thoracic paravertebral blocks for video-assisted thoracoscopic surgery: a randomised trial. Eur J Anaesthesiol 2020
  PubMedGoogle Scholar
• 37 Er J, Xia J, Gao R, Yu Y. A randomized clinical trial: optimal strategies of paravertebral nerve block combined with general anesthesia for postoperative analgesia in patients undergoing lobectomy: a comparison of the effects of different approaches for serratus anterior plane block. Ann Palliat Med 2021; 10 (11) 11464-11472
  CrossrefPubMedGoogle Scholar
• 38 Louis SG, King C, Baral P, Veeramachaneni N. Liposomal bupivacaine enhances the pain-control benefits of uniportal thoracoscopic lobectomy. Ann Thorac Surg 2019; 108 (05) 1514-1518
  CrossrefPubMedGoogle Scholar
• 39 Ponholzer F, Ng C, Maier H. et al. Intercostal catheters for postoperative pain management in VATS reduce opioid consumption. J Clin Med 2021; 10 (02) 372-380
  CrossrefPubMedGoogle Scholar
• 40 Yu Y, Cui L, Qian L. et al. Efficacy of perioperative intercostal analgesia via a multimodal analgesic regimen for chronic post-thoracotomy pain during postoperative follow-up: a big-data, intelligence platform-based analysis. J Pain Res 2021; 14: 2021-2028
  CrossrefPubMedGoogle Scholar
• 41 Hsieh MJ, Wang KC, Liu HP. et al. Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection. J Thorac Dis 2016; 8 (12) 3563-3571
  CrossrefPubMedGoogle Scholar
• 42 Hu L, Xu X, Tian H, He J. Effect of single-injection thoracic paravertebral block via the intrathoracic approach for analgesia after single-port video-assisted thoracoscopic lung wedge resection: a randomized controlled trial. Pain Ther 2021; 10 (01) 433-442
  CrossrefPubMedGoogle Scholar
• 43 Yang J, Hao Z, Li W. et al. The efficacy and safety of paravertebral block combined with parecoxib during video-assisted thoracic surgery: a randomized controlled trial. J Pain Res 2020; 13: 355-366
  CrossrefPubMedGoogle Scholar
• 44 Ueda K, Hayashi M, Murakami J, Tanaka T, Utada K, Hamano K. Intercostal block vs. epidural analgesia in thoracoscopic lung cancer surgery: a randomized trial. Gen Thorac Cardiovasc Surg 2020; 68 (03) 254-260
  CrossrefPubMedGoogle Scholar
• 45 Deng K, Xu SJ, Qian YF. et al. [Application of continuous serratus plane block with patient-controlled analgesia on postoperation analgesia after thoracoscopic surgery]. Zhonghua Yi Xue Za Zhi 2018; 98 (08) 570-575
  PubMedGoogle Scholar
• 46 Doi R, Miyazaki T, Tsuchiya T. et al. Mirogabalin treatment of postoperative neuropathic pain after thoracic surgery: study protocol for a multicenter, randomized, open-label, parallel-group, interventional trial. J Thorac Dis 2021; 13 (10) 6062-6070
  CrossrefPubMedGoogle Scholar

• Supplementary Material