Persistent post sternotomy chest pain: Does sternal wire removal have a role?

Nasr, Mohamed; Taha, Abdel-Hady M.

doi:10.1016/j.jescts.2017.04.004

Cited by 6 publications

(4 citation statements)

References 19 publications

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“…While Abo El Nasr et al, in their retrospective study, found that removal of sternal wires was effective in management of chronic post-sternotomy pain, their study didn't mention the technique used for sternal closure done to their patients. 20 In conclusion, it is well established that there are several risk factors that lead to post-sternotomy complications. Most authors agree that the most important one is sternal stability after closure.…”

Section: Discussionmentioning

confidence: 94%

Prakash versus figure of eight technique in sternal closure in CABG patients

Elsaify¹,

Soltan

Soliman

et al. 2019

Int Surg J

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Background: Median sternotomy was recommended in 1957 by Julian for complete exposure of the heart. Despite the high importance of correct sternotomy, proper sternal closure is vital to ensure fewer post-operative complications. The sternum can be closed by wires and other methods. Sternal closure using the most suitable technique can dramatically reduce the risk of development of such complications.Methods: It is a prospective randomized comparative study of two patient groups, each included 30 patients, diagnosed of ischemic heart disease and underwent CABG. Group A with the patients’ sterna closed by figure of eight method and group B with multi-twist (Prakash) technique. Both groups were compared regarding postoperative pain and complications as superficial and deep sternal wound infections (SSWI, DSWI), wire removal and rewiring within six months of follow up.Results: The mean of minimum post sternotomy pain in group A patients was 24.50±11.7, whereas in patients of group B, it was 27±10.1. Only two patients (group A) suffered sternal dehiscence within six months follow up. The incidence of SSWI and DSWI among both groups was almost similar with only two patient of group A needed wire removal and one of them required rewiring.Conclusions: The multi-twist sternal closure provides better sternal stability after CABG especially in patients who are vulnerable to sternal dehiscence.

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Section: Discussionmentioning

confidence: 94%

Prakash versus figure of eight technique in sternal closure in CABG patients

Elsaify¹,

Soltan

Soliman

et al. 2019

Int Surg J

View full text Add to dashboard Cite

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“…Besides, given that the groups were divided based on intraoperative nociception, such differences were not expected. Previous studies have shown that if differences exist, they would happen on the postoperative period and be related with sternum stability or reaction/irritation caused by the wire 26–28 …”

Section: Discussionmentioning

confidence: 99%

Retrospective assessment of the relationship between intraoperative nociception and postoperative analgesia requirements in dogs undergoing thoracic surgery

Corrêa¹,

Grados²

2021

Veterinary Record

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Background The analgesia management of thoracic surgery can be challenging and debate exists regarding the efficacy of pre‐emptive analgesia and its relationship with postoperative pain. The aim of this study was to assess the relationship between intraoperative nociception and postoperative pain in dogs undergoing thoracic surgery. If proven, effective prevention of intraoperative nociception could imply prospective lower postoperative analgesia requirements. Methods The study was retrospective and observational. Clinical records from dogs undergoing thoracic surgery (2015–2019) were reviewed and cases were allocated to one of two groups: NOCI‐FREE – dogs with no evidence of intraoperative nociception; NOCI – dogs that required intraoperative rescue analgesia to address a nociceptive response. Pre‐anaesthetic medication, locoregional analgesia, intraoperative infusions and rescue analgesia were used. Additionally, postoperative pain scores and analgesia plans were registered and compared between groups. Results Our study failed to identify a difference in the postoperative pain scores and analgesia requirements between dogs having signs of intraoperative nociception and those without. Additionally, the use of postoperative analgesic preventive infusions and rescue analgesia was similar for both NOCI and NOCI‐FREE. Being on an intraoperative infusion of opioids, dexmedetomidine or lidocaine was identified as a protective factor for nociception [OR = 11; (4.15–29.7)]. Conclusions In the population studied, it appears that dogs showing signs of nociception intraoperatively do not necessarily show higher pain scores nor do they need additionally pain relief in the postoperative period.

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“…Pain, functional impairment, and discomfort may be explained by the excessive motion of the sternal edge, which induces an inflammatory response, and which, in turn, promotes bacterial colonization and infection. Some studies suggest that pain may be related to hypersensitivity reaction to wire, scar entrapped neuralgia, and sternal irritations [21] . All study patients underwent treatment of surgical wound infections using the VAC system.…”

Section: Discussionmentioning

confidence: 99%

Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary Function of Patients with Sternal Instability after Cardiac Surgery

Nozawa¹,

Gonçalves²,

Almeida³

et al. 2020

Braz J Cardiovasc Surg

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Objective: To compare physical therapy strategies involving abdominal muscle stabilization, with and without upper limb movement, in patients with sternal instability after heart surgery and during in-hospital care.Methods: This prospective, longitudinal, randomized, and comparative clinical study included 20 patients, which were divided into two groups: ARM, the arm group (n=10), and LEG, the leg group (n=10). The study involved the evaluation of scores of visual analog scales for sternal instability, pain, discomfort, functional impairment, lung function, and maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) before and after the interventions. Two protocols consisting of abdominal exercises in both groups with upper limb movements (ARM) and just abdominal activation with leg movements (LEG) were used for three weeks.Results: There were statistically significant (P≤0.01) improvements in pain, discomfort, and functional impairment scores, and in MIP (P=0.04) and MEP (P≤0.01) after intervention in both groups and just LEG showed improvement in forced vital capacity (P=0.043) and forced expiratory volume in one second (P=0.011).Conclusion: Both strategies promoted improvement in pain, discomfort, and functional impairment scores and in the values of inspiratory and expiratory pressures. Perhaps they were influenced by the time and resolution of the infection process, although exercises with upper limb movements seem to be safe in this population. The activation of the infra-abdominal muscles through leg movements seems to bring more benefits to lung function.

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Persistent post sternotomy chest pain: Does sternal wire removal have a role?

Cited by 6 publications

References 19 publications

Prakash versus figure of eight technique in sternal closure in CABG patients

Prakash versus figure of eight technique in sternal closure in CABG patients

Retrospective assessment of the relationship between intraoperative nociception and postoperative analgesia requirements in dogs undergoing thoracic surgery

Infra-Abdominal Muscles Activation Brings Benefits to the Pulmonary Function of Patients with Sternal Instability after Cardiac Surgery

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