IJCS | Volume 33, Nº1, January / February 2019

DOI: 10.5935/2359-4802.20190048 24 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2020;33(1):24-33 Mailing Address: Juliana Silva Av. Washington Soares, 1321. Postal Code: 60811-905, Edson Queiroz, Fortaleza, CE – Brazil. E-mail: s.juliana.fernandes@gmail.com Minimally Invasive Cardiac Surgery versus Sternotomy - Pain Investigation Juliana Fernandes Silv a, M arcela Paula Cavalcant e, R oger Benevides Montenegr o, R omulo Lir a, E manuel Carvalho Mel o, Josue Viana Castr o Universidade de Fortaleza (UNIFOR), Fortaleza, CE - Brazil Manuscript received on March 20, 2018, revised manuscript on December 02, 2018, accepted on February 17, 2019. Abstract Background: Treatment of postoperative (PO) pain is essential after surgery, as it contributes to a faster rehabilitation. Assessment of PO pain after minimally invasive (MI) surgery has not been regularly addressed, especially when compared with median sternotomy (MS). Objective: This study aims to evaluate the intensity of thoracic pain in the PO period in patients subjected to MI surgery and MS. Methods: This study compared the intensity of thoracic pain in 34 patients subjected to minimally invasive (MI; n = 17) and median sternotomy (MS; n = 17) from June 2015 to June 2016. The intensity and sites of pain in the PO period, assessed using the visual numeric pain scale, and the need for pain medications were analyzed using the Student’s t-test and the z test, with confidence level of 95% (p < 0.05). Results: Almost all patients reported pain on the third PO day (MS = 94.1% and MI = 88.2%; p = 0.5410). On the seventh PO day, there were significantly more patients free of pain in the group of patients subjected to the MI procedure (MS = 94.1% and MI = 64.7%; p = 0.0341). also, these patients reported fewer pain sites (3 rd PO day: MS = 3.2 ± 1.5; MI = 1.5 ± 1.2; p = 0.001; 7 th PO day: MS = 3.1 ± 1.4; MI = 0.9 ± 0.9; p = 0.000). Patients undergoing MS reported higher pain intensity and longer lasting pain (3 rd PO: MS = 4.8 ± 2.2; MI = 3.0 ± 1.6; 7 th PO: MS = 5.3 ± 2.0; MI = 1.2 ± 1.3; p = 0.001), with no difference in pain intensity between the third and the seventh PO days (p = 0.4931). In addition, patients subjected to MI procedure had a significant decrease in pain intensity from the third to the seventh PO days (p = 0.001). Conclusion: According to these results, we concluded that a MI procedure leads to lower intensity of pain in the PO period (from the third PO day on) when compared to a MS; also, patients undergoing MI patients reported fewer pain sites. (Int J Cardiovasc Sci. 2020;33(1):24-33) Keywords: Minimally Invasive Surgical Procedures; Cardiovascular Surgical Procedures; Sternotomy; Postoperative Care. Introduction Minimally invasive (MI) cardiac surgery is a safe procedure with similar mortality and morbidity, but better surgical outcomes compared with conventional sternotomy (MS) in some groups of patients. 1–4 The potential benefits of MI procedures include better stability of the sternum in the postoperative period, with implications on deep infection prevention, improvement of respiratory function, mobility and bleeding. 5 The MI approach was introduced to reduce surgical trauma with better cosmetic results; this approach is currently applied to procedures including valve and septal defect surgeries. 6,7 Pain has been shown to be one of the primary sources of concern in surgical patients, 8 even though it is expected in the postoperative (PO) period. Inadequate management of pain can have profound clinical (deep vein thrombosis, pulmonary embolism, coronary ischemia, myocardial infarction, pneumonia, and poor wound healing) and