Ultrasound-guided perineural intercostal autologous platelet-rich plasma in the treatment of chronic post-thoracotomy pain syndrome – A prospective case series

Background

Post-thoracotomy pain syndrome poses a significant challenge in clinical management due to its debilitating nature. Current treatment strategies often involve multimodal approaches, including pharmacology and interventional procedures. Recently, platelet-rich plasma has emerged as a potential therapeutic option for chronic neuropathic pain, yet its efficacy in post-thoracotomy pain syndrome remains unexplored.

Methods

This prospective consecutive case series aimed to evaluate the effectiveness of autologous platelet-rich plasma in alleviating chronic post-thoracotomy pain syndrome. Ten patients with persistent thoracic post-surgical pain were consecutively recruited. Platelet-rich plasma was administered via ultrasound-guided perineural intercostal injections. Pain intensity, opioid consumption, and quality of life were assessed pre-treatment and at one- and three-month follow-ups.

Results

Platelet-rich plasma administration led to a significant reduction in pain intensity, with median Numerical Rating Scale scores decreasing from 8.5 to 3.0 at one month and 4.0 at three months post-treatment. At one month, 90 % of patients achieved a reduction in NRS scores exceeding the minimal clinically important difference (95 % CI: 71 %, 109 %), and this proportion was maintained at three months. Although opioid consumption showed a downward trend, it did not reach statistical significance. Improvements were observed in the EQ-5D-3L index and visual analogue scale scores, indicating enhanced quality of life post-treatment.

Conclusions

This prospective consecutive case series suggests that autologous platelet-rich plasma may offer a promising adjunctive therapy for chronic post-thoracotomy pain syndrome. However, limitations including the lack of a control group and small sample size underscore the need for further research to establish the efficacy and optimize the application of platelet-rich plasma in managing post-thoracotomy pain syndrome.