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M. Rusca, P. Carbognani and P. Bobbio, “Cervicothoracic Tumors: Results of Resection by the ‘Hemi-Clamshell’ Approach,” Journal of Thoracic and Cardiovascular Surgery, Vol. 117, No. 5, 1999, p. 1040. doi:10.1016/S0022-5223(99)70400-9

has been cited by the following article:

• TITLE: Thoracic Epidural Morphine for Postoperative Analgesia after Hemiclamshell Incision in Castleman Disease

  AUTHORS: Borja Mugabure, María Eizaguirre, Silvia González, José Miguel Izquierdo, Borja Aguinagalde, Javier Martín, Pedro Martínez

  KEYWORDS: Hemiclamshell; Epidural Morphine; Postoperative Pain; Multimodal Analgesia

  JOURNAL NAME: Open Journal of Anesthesiology, Vol.3 No.3, May 13, 2013

  ABSTRACT: The hemiclamshell incision is a valid but infrequent surgical alternative for the resection of tumors from mediastinum. This point makes this approach impossible to be studied under a randomized controlled trial. The triple association of thoracotomy, sternotomy and cervicothomy makes the hemiclamshell approach a high intensity postoperative pain surgery. However, there is no published data on this topic, and the reviewed articles only mention the analgesic regimens as a secondary point. Indeed, no author defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on regional anesthesia should be used. Based on the recent advances on spinal opioids, morphine could be a good choice as epidural coadjutant to local anesthetics for hemiclamshell incision.