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BJA Advance Access originally published online on May 13, 2005
British Journal of Anaesthesia 2005 95(2):153-158; doi:10.1093/bja/aei152
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org

Dysaesthesia associated with sternotomy for heart surgery{dagger}

R. P. Alston* and P. Pechon

Department of Anaesthesia, Critical Care and Pain Medicine and Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK

* Corresponding author. E-mail: peter.alston{at}ed.ac.uk

Background. Chronic pain occurs in 40–50% patients following cardiac surgery. Dysaesthesia, either in the form of heightened or diminished skin sensation, are frequently associated with chronic neuropathic pain. Therefore, dysaesthesia in the early postoperative period may predict chronic pain. However, the character and causes of dysaesthesia in the early postoperative period are unknown. The aim of this study was to investigate the incidence, extent, and causes of dysaesthesia following cardiac surgery by sternotomy.

Methods. In a prospective cohort study, 50 patients undergoing sternotomy for cardiac surgery were admitted to the study: 38 underwent coronary artery bypass graft (CABG), nine valve surgery, and three combined surgery. Forty-eight hours postoperatively, acute pain was measured by four-point verbal scale. Manual pinprick and cotton wool brushing was used to detect the areas of dysaesthesia.

Results. Some form of dysaesthesia was found in 27 (54%) of the patients. Using multivariate regression analysis, the total area of dysaesthesia was positively associated with CABG surgery and the severity of postoperative pain (P<0.001).

Conclusion. Dysaesthesia is common in the early postoperative period following cardiac surgery using a sternotomy and is associated with CABG surgery. The association with severity of pain may indicate a neuropathic element that is unrelieved by conventional opioid analgesia.

{dagger} Presented at the Association of Cardiothoracic Anaesthetists Meeting, November 2003, Institute of Electrical Engineers, London and the World Congress of Anaesthesiologists, Paris, 21st April, 2004.


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Pain memory can be a factor for dysaesthesia in CABG patients
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British Journal of Anaesthesia, 2 Aug 2005 [Full text]

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