Bedside diagnosis of persistent post-sternotomy pain

Acupuncture and trigger point injection in the management of poststernotomy pain syndrome: A case series study

BACKGROUND

Poststernotomy pain syndrome (PSPS) is defined as chronic pain after thoracic surgery persisting for at least 2 months and without apparent cause. The incidence of PSPS after surgery is reported to be between 7% and 66%. Currently, there is no standard protocol for management of such cases, and treatment modalities are mainly directed towards the use of various analgesics. Numerous other approaches have been tried in order to relieve this pain, including osteopathy, trigger point infiltration and acupuncture.

METHODS

A case series study was conducted; data were collected from 20 patients seeking pain relief for poststernotomy pain, at the Outpatient Pain Clinic, National Research Center, Cairo, Egypt. Treatment consisted of local wound infiltration with lidocaine 1% and acupuncture. Each patient was scheduled for twice weekly sessions over a period of 4 weeks. Pain was measured using visual analogue scales (VAS) pre and post each treatment session.

RESULTS

Out of the 20 patients, 15 participants completed all 8 sessions. They reported improvement in their chest wall pain, compared to their initial presenting state. There was a significant decrease in pain score from initial VAS to first measurement (p = 0.001), between 3 and 4 (p = 0.014), 4 and 5 (p = 0.013), 5 and 6 (p = 0.014) and between 6 and 7 measurement (p = 0.008).

CONCLUSION

The dual approach of acupuncture and trigger point injection for PSPS patients offer a promising means of pain relief. Controlled studies with larger numbers of patients are required.

Post-sternotomy pain syndrome following cardiac surgery: case report

Over 2 million people undergo sternotomy worldwide for heart surgery each year, and many develop post-sternotomy pain syndrome (PSPS) which persists in the anterior thorax. In some patients, PSPS lasts for many years or suddenly reappears a long time after the sternotomy. The exact etiology of PSPS is unknown. This article presents a case report of a patient with a diagnosis of PSPS (after cardiac surgery 4 years prior) for whom an osteopathic approach was used, which successfully eliminated the pain. In a previous study, we demonstrated that this osteopathic procedure could reduce sternal pain associated with a recent surgical wound. Further efforts are needed to understand the reasons for PSPS. In light of new scientific data, these osteopathic techniques could contribute to a multidisciplinary approach to solve the problem.

Median sternotomy - gold standard incision for cardiac surgeons

Sternotomy is the gold standard incision for cardiac surgeons but it is also used in thoracic surgery especially for mediastinal, tracheal and main stem bronchus surgery. The surgical technique is well established and identification of the correct anatomic landmarks, midline tissue preparation, osteotomy and bleeding control are important steps of the procedure. Correct sternal closure is vital for avoiding short- and long-term morbidity and mortality. The two sternal halves have to be well approximated to facilitate healing of the bone and to avoid instability, which is a risk factor for wound infection. New suture materials and techniques would be expected to be developed to further improve the patients evolution, in respect to both immediate postoperative period and long-term morbidity and mortality.