The incidence of chronic post-sternotomy pain after cardiac surgery - a prospective study

Background: Post-sternotomy pain is sometimes a sequela of cardiac surgery. The incidence, characteristics and clinical course of post-sternotomy pain are not well known. The aim of our study was to determine the incidence of chronic post-sternotomy pain in patients undergoing sternotomy for cardiac surgery in general and according to the specific surgical procedure. Method: In a prospective manner, a group of 349 consecutive patients were e valuated for chronic post-sternotomy pain one year after surgery. The patie nts were asked in a postal questionnaire to describe and score any persiste nt pain following the surgical procedure. The patients were classified into 3 subgroups according to surgical procedure. The first group consisted of patients operated for coronary artery by-pass grafting (CABG) including int ernal thoracic artery grafting (ITAG). The second group included patients o perated with CABG without ITAG and the third group of patients with valve r eplacement without CABG. Result: A total of 318 patients (91%) answered the questionnaire of whom 90 (28%) reported chest discomfort different from what they experienced befor e surgery. The scoring on the visual analogue scale (VAS, 0-100 mm) showed that 41 patients (13%) reported maximum pain intensity greater than or equa l to 30 mm (moderate pain), and 14 of these patients (4%) scored greater th an or equal to 54 mm (severe pain). There was no statistically significant difference in pain incidence and pain intensity when comparing the patients subjected to different surgical procedures. Conclusions: This prospective study shows that the overall incidence of non -cardiac pain after sternotomy for cardiac surgery is high (28%). Most pati ents experience a modest pain intensity but some (1%) report severe pain, n ever being lower than 54 mm on VAS. The study also indicates that the incid ence of pain after sternotomy is not only associated with harvest of the IT A and additional aetiological factors must be sought.