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Cardiothoracic Surgery |

Sternal Pain After Rigid Fixation: A Pilot Study of Randomization Rigid vs Conventional Wire Closure

Hong Mun Kong*, BS; Shigeki Tabata, MD; Kentaro Yamane, MD; Margaret Lusardi, MD; Linda Bogar, MD; Albert Guerraty, MD; James Diehl, MD; Hitoshi Hirose, MD
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Thomas Jefferson University, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):78A. doi:10.1378/chest.1377684
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Abstract

SESSION TYPE: Cardiac Surgery Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Rigid sternal fixation may provide better sternal closure than conventional sternal wire closure. We performed a prospective randomized study to investigate if rigid closure reduces postoperative sternal pain.

METHODS: Patients undergoing CABG ± valve surgery between July 2011 and January 2012 were prospectively randomized into conventional wire closure (group C) or rigid fixation using sternal plates (group R). Pain scores were determined at 6 AM using a numeric rating scale (0 no pain, 5 moderate pain, 10 worst possible pain). Narcotic pain medication requirement from day 1 to 5 was collected and converted into intravenous morphine equivalent.

RESULTS: Among the total of 26 patients, 11 patients were in Group R (10 male and 1 female, age 67 ± 8.0) and 15 patients were in Group C (13 male and 2 female, age 66 ± 9.9). Preoperative risk factors and procedure were identical between the two groups. Pain scores were not significantly different between 2 groups. Narcotic requirement was smaller in group R (15.7 mg intravenous morphine equivalent in group R in day 1vs 18.4 mg intravenous morphine equivalent in day 1 in group C in day 1, 13.1 mg vs 12.5 mg in day 2, 9.4 mg vs 10.5 mg in day 3, 6.9 mg vs 7.7 mg in day 4, and 6.2 mg vs 6.9 mg in day 5) than group C. Total iv narcotic given over 5 days was 24 ± 41 mg in group R and 34 mg ± 54 mg in group C (p=0.60).

CONCLUSIONS: Randomized data rom this ongoing study showed a trend of fewer narcotic requirement especially intravenous narcotics in group R than in group C.

CLINICAL IMPLICATIONS: Rigid fixation may potentially improve immediate sternal pain after open heart surgery. Less narcotic requirement potentially facilitate early return to the daily activity.

DISCLOSURE: The following authors have nothing to disclose: Hong Mun Kong, Shigeki Tabata, Kentaro Yamane, Margaret Lusardi, Linda Bogar, Albert Guerraty, James Diehl, Hitoshi Hirose

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Thomas Jefferson University, Philadelphia, PA

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