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International Society For Minimally Invasive Cardiothoracic Surgery

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Importance Of Pain Management After Cardiac Surgery
Danily S. Villar, Emilie Daigle, Jennifer Cogan, Raymond Cartier.
Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.

BACKGROUND: Minimally invasive approaches in cardiac surgery are advocated to decrease pain, hospital stay and postoperative complications. We looked into postoperative pain management in three different approaches for aortic valve replacement (AVR). METHODS: A retrospective single-center study included 300 patients who underwent AVR between May 2014 and October 2018. Study population was divided into three groups: sternotomy (ST) (n=100), ministernotomy (MST) (n=100), and minithoracotomy (MTH) (n=100). Daily pain management was provided by a dedicated anesthesiologist team. RESULTS: Mean age was 71.2+9.04 years. Patients from the ST group were younger (p<0.05). Chronic lung disease was more prevalent in the MST group (p<0.01). A multimodal pain management involving narcotics, pleural injection, and oral analgesia was used in all patients while regional block was used as supplementary treatment in MTH only. There was no difference in mortality, arrhythmias, infections, renal function, and neurological complications. A trend was observed towards lower resting pain on the first day in the MTH group (p=0.06). No significant difference in mobilization pain score was observed for the first 3 postoperative days. Painkiller use (mg) was also comparable in the 3 groups. All patients were extubated in the first 24 hours. There was no significant difference in the intensive care unit and hospital stay. CONCLUSIONS: This study suggests that proper pain management during acute postoperative period seems to be a more significant factor than the surgical approach used in reducing postoperative pain.


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