Comparison of pain in the early post-operative period using VAS score in patients after cardiac surgery who had minimally invasive incisions vs. full median sternotomy

Abstract

OBJECTIVE: Postoperative pain after open heart surgery is one of the most important factors affecting postoperative morbidity1. Interventions for anterior right thoracotomy for the treatment of atrial septal defects (ASD), and on mitral and tricuspid valves were used in the 1970s 2. Currently, minimally invasive surgery is increasingly used in cardiac surgery in recent years because it offers a cosmetic advantage with an incision line under the breast and guarantees easy exposure 2. As is known, exposure with mini sternotomy or with mini thoracotomy is frequently used, causing less damage to tissues, although sometimes it is technically difficult to obtain the desired exposure without increasing the opening of the retractor to improve the viewing angle. This causes tissue tension or bone fracture, with aggravation of postoperative pain and lengthening of convalescence.

METHODS: We used the visual analogue scale (VAS) for postoperative pain assessment among 15 patients who underwent minimally invasive surgery compared to 15 who underwent total median sternotomy in 2017, to compare the outcome in postoperative pain between the two groups. Our initial measurements were performed in the intensive care unit within the first 6 hours after early extubation. on the third day post-operative, at discharge and in the first week after. The start of postoperative exercises (respiratory exercises, mobilization), their efficiency, the extent of drainage, the extubation time and the duration of the intensive care stay were also recorded.

RESULTS: After an initial slight increase in scores in patients undergoing minimally invasive cardiac surgery in the first period, a general state of well-being, comfortable mobilization and greater success in postoperative exercises were observed starting from the 1st postoperative day. With respect to conventional surgery, discharge was more precocious, lower pain and improved signs of well-being during the postoperative follow-up of the first week.

CONCLUSION: Despite the limitation due to the limited number of patients studied, we believe that future studies conducted with larger patient groups would further support our findings.