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

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COD: 01_2019_02_2970 Categorie: ,

Kenan Abdurrahman Kara, Tolga Caner

Ann Ital Chir, 2019 90, 1: 3-9
Epub Ahead of Print – October 29

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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.

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