Pain and Functionality Following Sternotomy: A Prospective 12-Month Observational Study

Veal, Felicity; Bereznicki, Lre; Thompson, Angus; Peterson, Gregory M.; Orlikowski, Christopher E. P.

doi:10.1093/pm/pnv066

Cited by 6 publications

(12 citation statements)

References 31 publications

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“…Comorbid conditions complicate and cause functional and emotional impairment in the daily life of men and women following cardiac surgery. 3 , 4 In our sample, both men and women reported associated back/neck problems, depression, and persistent pain intensity with lower HRQoL up to 12 months after surgery. 2 The differences in pain experience in individuals with depression compared to individuals without depression seem to be pronounced.…”

Section: Discussionmentioning

confidence: 68%

“…Despite research efforts, 6 – 8 it has been difficult to identify individuals who are susceptible to more severe postoperative pain than others. 7 Higher ratings of acute pain intensity and risk for persistent cardiac surgical pain have been linked to female sex, 9 – 11 younger age, 3 , 12 lower socioeconomic status (e.g., lower education, living alone), 11 comorbidities, 11 preoperative pain, 3 and analgesic consumption in the early postoperative phase. 9 , 11 However, individuals’ pain experiences also revolve around their response to psychological, social, and emotional stimuli, 6 which may explain variability in self-perceived pain sensitivity and why clinical and demographic factors are not consistently found to influence the risk for persistent surgical pain.…”

Section: Introductionmentioning

confidence: 99%

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Association between self-perceived pain sensitivity and pain intensity after cardiac surgery

Bjørnnes¹,

Lie²,

Parry³

et al. 2018

JPR

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Background and purposeCardiac surgical pain remains a clinical challenge affecting about 40% of individuals in the first six months post-cardiac surgery, and continues up to two years after surgery for about 15–20%. Self-perceived sensitivity to pain may help to identify individuals at risk for persistent cardiac surgical pain to optimize health care responses. The purpose of this study was to assess the relationship between self-perceived pain sensitivity assessed by the Pain Sensitivity Questionnaire (PSQ) and postoperative worst pain intensity up to 12 months after cardiac surgery. Sex differences in baseline characteristics and the PSQ scores were also assessed.MethodsThis study was performed among 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery between March 2012 and September 2013. A secondary data-analysis was utilized to explore the relationship between preoperative PSQ scores and worst pain intensity rated preoperatively, across postoperative Days 1–4, at 2 weeks, and at 1, 3, 6, and 12 months post-surgery. Linear mixed model analyses were performed to estimate changes in pain intensity during 1-year follow-up.ResultsThe mean (±standard deviation) PSQ-total score was 3.3±1.4, with similar scores in men and women. The PSQ-total score was significantly associated with higher worst pain intensity ratings adjusted for participant characteristics (p=0.001).ConclusionUse of the PSQ before surgery may predict cardiac surgical pain intensity. However, previous evidence is limited and not consistent, and more research is needed to substantiate our results.

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Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Association between self-perceived pain sensitivity and pain intensity after cardiac surgery

Bjørnnes¹,

Lie²,

Parry³

et al. 2018

JPR

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“…In favor of the particular trauma of sternotomy is evidenced by a pronounced pain syndrome, which is often chronic in nature and requires repeated use of analgesics. [1][2][3] Of a number of negative aspects of longitudinal median sternotomy, it is necessary to note a rather high incidence of postoperative proinflammatory complications, which, according to many studies, reaches up to 5%. 4,5 The most formidable of the infectious complications are mediastinitis and osteomyelitis of the sternum and ribs.…”

Section: Discussionmentioning

confidence: 99%

“…Sternotomy in the postoperative period can be cause of intense and prolonged pain syndrome. 1,2 Chronic pain syndrome after cardiac surgery can be one of the main factors worsening the general condition of patients, increases the rehabilitation period and worsens the quality of life. 3 Transsternal approach is also characterized by a rather high frequency of purulent postoperative complications.…”

Section: Introductionmentioning

confidence: 99%

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

2021

jcdr

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Background: In this report presented the results of surgical correction in septal defects associated with congenital heart defects from right-sided lateral thoracotomy. Carried out comparative assessment of perioperative indicators, such as the duration of the operation, the duration of artificial circulation, the duration of artificial ventilation of the lungs, the time of staying patients in the intensive care unit and postoperative hospital days in patients operated from right-sided lateral thoracotomy and standard longitudinal sternotomy.Methods: Were analyzed the results of surgical treatment of 150 patients with isolated heart septal defects, a combination of heart septal defects with pulmonary artery stenosis, with anomalies of the inflow of the pulmonary veins, with atrioventricular valve pathologies, as well as with aortic valve insufficiency. All patients were divided into two groups of equal number of patients. I -group (main group) of 75 patients operated on from a right-sided lateral thoracotomy. II -group (control group) 75 patients operated on from a median longitudinal sternotomy.Results: In the group of patients operated from lateral thoracotomy, there was a significant reduction in the total duration of operation, a shortening of the time of artificial lung ventilation, the length of stay of patients in the intensive care unit and reduction of postoperative hospital days. The duration of cardiopulmonary bypass among patients of both groups did not differ significantly, being 35.6 ± 3.45 minutes in the main group, and 39.48 ± 3.48 minutes in the control group, p = 0.43.All performed operations from right-sided thoracotomy access proceeded without technical difficulties, and the stages of elimination of existing defects were carried out in full according to the standard protocol. In no case was there a need for conversion. Patients were particularly satisfied with the achieved cosmetic effect. Conclusions:Based on the obtained results, the authors of the report came to the conclusion that right-sided thoracotomy can be used as an alternative surgical access to the standard sternotomy access in the surgery of septal defects and some congenital heart defects associated with it in conditions of artificial circulation. This access is less traumatic, better tolerated by patients and subsequently gives fewer complications.

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“…A significant proportion of patients experience sternal pain and other associated neuro-musculoskeletal complications following median sternotomy which can impact upper limb and trunk function, activities of daily living and health-related quality of life. 1–5 To date, the predominant way of assessing function following cardiac surgery has not focused on specific evaluation of the site of surgery and the functional performance of the upper limb and thoracic region that is impacted by the procedure. 6,7 A review of the literature revealed that evaluation has focused on self-reported pain and quality of life or the use of shoulder outcome tools that target acute injury.…”

Section: Introductionmentioning

confidence: 99%

Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function

et al. 2019

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Objective: The aim of this study was to investigate the psychometric properties of the shortened version of the Functional Difficulties Questionnaire (FDQ). Design: This is a multisite observational study. Setting: The study was conducted in four tertiary care hospitals in Australia. Subjects: A total of 225 participants, following cardiac surgery, were involved in the study. Intervention: Participants completed the original 13-item FDQ and other measures of physical function, pain and health-related quality of life. Method: Item reduction was utilized to develop the shortened version. Reliability was evaluated using intraclass correlation coefficients (ICCs), the smallest detectable change and Bland–Altman plots. The validity and responsiveness were evaluated using correlation. Anchor and distribution-based calculation was used to calculate the minimal clinical important difference (MCID). Results: Item reduction resulted in the creation of a 10-item shortened version of the questionnaire (FDQ-s). Within the cohort of cardiac surgery patient, the mean (SD) for the FDQ-s was 38.7 (19.61) at baseline; 15.5 (14.01) at four weeks and 7.9 (12.01) at three months. Validity: excellent internal consistency (Cronbach’s α > 0.90) and fair-to-excellent construct validity (>0.4). Reliability: internal consistency was excellent (Cronbach’s α > 0.8). The FDQ-s had excellent test–retest reliability (ICC = 0.89–0.92). Strong responsiveness overtime was demonstrated with large effect sizes (Cohen’s d > 1.0). The MCID of the FDQ-s was calculated between 4 and 10 out of 100 (in cm). Conclusion: The FDQ-s demonstrated robust psychometric properties as a measurement tool of physical function of the thoracic region following cardiac surgery.

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Pain and Functionality Following Sternotomy: A Prospective 12-Month Observational Study

Cited by 6 publications

References 31 publications

Association between self-perceived pain sensitivity and pain intensity after cardiac surgery

Association between self-perceived pain sensitivity and pain intensity after cardiac surgery

Right thoracotomy - an alternative surgical access in the surgery of congenital heart defects

Psychometric evaluation of the shortened version of the Functional Difficulties Questionnaire to assess thoracic physical function

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