TY - CHAP M1 - Book, Section TI - Chapter 18. Postoperative Analgesia for Cardiac Surgery A1 - Wasnick, John D. A1 - Hillel, Zak A1 - Kramer, David A1 - Littwin, Sanford A1 - Nicoara, Alina PY - 2011 T2 - Cardiac Anesthesia and Transesophageal Echocardiography AB - Cardiac surgery can be associated with a significant amount of postoperative pain. Common sources include median sternotomy or thoracotomy incisions, rib retraction, harvesting of vessels from the forearm or legs for grafting, dissection of internal mammary arteries, and the presence of (and removal of) chest drains. Other potential causes include incomplete revascularization of the myocardium, the presence of sternal wires or epicardial pacing leads, and sternocostal and costovertebral pain from excessive retraction.1 While some cardiac surgical techniques confer a greater amount of postoperative pain than others, postoperative pain management should be an anesthetic consideration for all patients undergoing cardiac surgery.The surgical approach has an obvious impact on the severity of postoperative pain. For example, minimally invasive cardiac procedures such as port access coronary artery bypass (PACAB) and minimally invasive coronary artery bypass (MIDCAB) carry less overall tissue injury and result in less postoperative pain. Postoperative pain for midline sternotomy has often been described to be moderate and patients' anticipated pain level tends to be much greater than the actual pain they experience postoperatively.2 On the other hand, thoracotomy has been associated with a greater degree of both pain and functional limitation, due to the pain associated with breathing and coughing.3 Endoscopic vein graft harvesting has decreased the severity of postoperative leg pain, as well as the infection and wound dehiscence rate.4Patient risk factors also play a role in the incidence and severity of postcardiac surgical pain, with younger patients (< 60 years old) and those with higher New York Heart Association (NYHA) class incurring higher pain scores.5,6 SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=8551835 ER -