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Chapter-37 Post CABG Scar Pain and Its Management

BOOK TITLE: Symptom Oriented Pain Management

Author
1. Lokapur Madhuri
ISBN
9789350257975
DOI
10.5005/jp/books/11597_37
Edition
1/e
Publishing Year
2012
Pages
4
Author Affiliations
1. Lokapur Pain Clinic, Pune Ruby Hall Clinic, Jehangir Hospital, Pune, Maharashtra, India
Chapter keywords

Abstract

Post coronary artery bypass grafting is one of the most common surgical procedures performed worldwide. Chronic postoperative pain is a well recognized problem. Sternotomy causes considerable postoperative pain and some patients reported with sleep disturbances due to the oststernotomy pain. Post-thoracotomy pain may be due to retraction, resection, or fracture of ribs, dislocation of costovertebral joints, injury of intercostal nerves etc. The signs and symptoms include moderate to severe chest wall pain, mechanical allodynia, dysaesthesia and elevated thermal thresholds etc., and patient may also exhibit signs of clinical depression and behavioral changes due to chronic illness. The clinical examination of a patient includes inspection of the scar and respiratory excursion movements, allodynia, costochondritis etc. The patient must be investigated by CT or MRI of thorax and cardiac function tests. The various treatment protocols include physiotherapy and osteopathy techniques, use NSAIDs, tricyclic antidepressants, antiepileptics, and low-dose opioids etc. Some patients require more sophisticated treatment such as trigger point injections, intra muscular stimulation, intercostals nerve blocks, sympathectomy, cryoneurolysis etc.

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