Pain Management after Cardiac Surgery:
Are We Underestimating Post Sternotomy Pain?
Kasana Raksamani MD*, Wanchai Wongkornrat MD**,
Paradee Siriboon MD*, Natthaphorn Pantisawat MD*
Affiliation :
* Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Good pain management can improve the outcome of patient care after cardiac surgery. The intensity of pain
after cardiac surgery is often underrated. Inadequate pain control can result in increased morbidity and length of hospital
stay as well as lead to chronic pain. Therefore, the authors conducted a study to identify the prevalence and risk factors of
moderate to severe pain after cardiac surgery including treatment and complication.
Material and Method: The present study was prospectively performed in the patients undergoing cardiac surgery with
median sternotomy in Siriraj Hospital, a tertiary care center, between July 2009 and November 2010. Pain was assessed
by numerical rating scale (NRS, 0-10) whilst NRS ≥4 was defined as moderate to severe pain. Pain score was recorded until
48 hours after surgery. Demographic data, history of previous cardiac and non-cardiac surgery, chronic pain history, details
of the operation, and intra-and postoperative analgesia were recorded, including complication of pain treatment. In addition,
pain expectation and experience were compared and the patient satisfaction was evaluated.
Results : Two hundred ninety patients were enrolled, 95.5% ASA physical status III, with mean duration of surgery
243.8 minutes (95-600) and cardiopulmonary bypass time 112.8 minutes (33-500). The prevalence of moderate to severe
pain in the patients after cardiac surgery was 61.4%. The duration of cardiopulmonary bypass less than 60 minutes decreased
numbers of patients with moderate to severe pain with adjusted OR ratio of 0.40, 95% CI = 0.16,1.004, (p<0.001).
Complications of pain treatment were respiratory depression (0.7%), nausea (25.6%), vomiting (11.4%), pruritus (4.1%),
and urinary retention (0.3%). The majority of the patients were satisfied with pain control (81.4%).
Conclusion : The prevalence of moderate to severe pain in the present study was high and duration of cardiopulmonary
bypass was the only factor affected. Still, most patients were satisfied with the pain treatment.
Keywords : Postoperative pain, Sternotomy, Cardiac surgery
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