The effect of the sternal closure techniques on pain severity after cardiac surgery
Abstract Sternal instability is one of the most frequent complications after sternotomy that is followed by pain syndrome in early and long-term postoperative periods and reduced patients' quality of life. Therefore, reliable fixation of the sternum is an important measure to prevent sternal instability. We performed a prospective, single-center, randomized, blind study with evidence level II. Envelope method was used to randomize 102 patients undergoing cardiac surgery with median sternotomy into 3 groups depending on the type of sternal closure. Group 1 consisted of 34 patients with steel wire fixation, group 2 includes 34 patients with nitinol clips and group 3 – 34 patients with cabletie based sternal closure device. In 3 days after surgery pain severity at rest and during movement was significantly lower in group 3 compared with control group 1 (0.5±1.1 vs. 1.2±1.8 and 3.3±1,8 vs. 4.2±2.2, respectively) and group 2 only in movement (3.3±1.8 vs. 4.2±1.9). In group 2 the level of pain was lower compared with group 1 at rest only. However, the differences were not significant. These values were similar in 8 days postoperatively. Within the same terms the incidence of sternal clicking in movement was 23.6%, crepitus – 14.7% in group 1. It was significantly greater than in group 2 (8.8 and 2.9% respectively) and in group 3 (5.9 and 2.9% respectively). Herewith the differences were significant only for crepitus. ZipFix devices (significantly) and nitinol staples (not significant) reduce the level of postoperative pain, incidence of sternal clicking and crepitus compared with conventional techniques of sternal closure. Thus, this approach improves patients' quality of life and reduces postoperative rehabilitation period.
Keywords:sternal closure, poststernotomy pain, cable-tie based sternal closure device, nitinol clips
Clin. Experiment. Surg. Petrovsky J. 2016. № 3. Р. 65–73.
Received: 11.05.2016. Accepted: 08.07.2016.
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