Baheti CABG Pain

8/7/2019 Baheti CABG Pain

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Post CABG Pain

Prof & HOD Dept. of Anesthesia & Pain, B.H.I.M.S.,

Pain Physician, Lilavati, Raheja,Shushrusha Hospital

Ex.President, IndianSociety forStudy of Pain,

Executive President, PainManagement and Research

Foundation Hobbies-Music, Sports [email protected] Web-www.paincure.in

Dr.D.K. Baheti
mailto:[email protected]:[email protected]


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Post CABG Pain

Dr.D.K.Baheti MD

Prof And HODDept of Anaesthesiology and Pain,

B.H.I.M.S. Mumbai-India


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DECLARATION

NO

COMMERCIAL

SUPPORT/INTEREST

FOR THIS PRESENTATION


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Post CABG PAIN

Common surgical procedure, its frequent complication,the post-CABG pain (PCP) syndrome, remains poorlydocumented

219 of the 387 respondents (56%) reported chest wallpain.

One hundred and forty-two (65%) of the patients withPCP reported pain of at least moderate severity, and151 (72%) reported that the pain interfered with theirdaily activities. Eighty PCP patients were available for adetailed evaluation. Left-sided chest wall pain wasnoted by 53 subjects, midline scar pain by 47, andright-sided pain by nine subjects


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POST CABG PAIN-Post Op Pain

PSP-Nociceptive (visceral or somatic),arising from tissue injury and inflammation,

Neuropathic, resulting from direct injury tonerves in either the central or PNS

CABG surgery involves many pain-sensitive structures, including sternotomyand leg incisions with invasion ofsubcutaneous muscle, bone, and visceraltissues.


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POST CABG PAIN

ACUTE

CHRONIC


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ACUTE PAIN


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ACUTE PAIN

Incision Pain-At Rest , Movement, Physiotherapy

Sternotomy pain

Chest wall pain

Scar pain : Persistent wound pain . Persistent pain was

defined as pain still present two or more monthsafter surgery,


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CHRONIC

InfectionChest Pain, Uneasiness, Compression feeling

Rule out Unstable AnginaNeuropathic Pain- Pain , Burning, Allodynia,

Hyperalgesia

Scar Pain- Redness, Itching, Burning, Keloid


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WHY TO TREAT?

Pulmonary and cardiovascular dysfunction; It is an exhausting experience that also causes

deconditioning, sleep deprivation, and poornutrition.

Physiotherapy and Ambulation delayed


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Post Sternotomy Pain

Overall incidence of non-cardiac pain after sternotomyfor cardiac surgery is high (28%). Most patientsexperience a modest pain intensity but some (1%)report severe pain, never being lower than 54 mm onVAS. The study also indicates that the incidence of pain

after sternotomy is not only associated with harvest of the ITA and additional aetiological factors must besought.

Re-1: Multidisciplinary Pain Treatment Centre,Department of Anaesthesiology, and Department of Thoracic and 2: Cardiovascular Surgery, UniversityHospital, Uppsala, Sweden


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Chronic Post-Surgical Pain(CPSP):Epidemiology and clinical implications -

Eric J. Visser , Royal Perth Hospital, Australia

CPSP is an under-recognised and prevalent healthcare problemassociated with significant morbidity and potential economic costs.

Risk factors-type of surgery, pre-existing pain, re-operation, nervedamage, moderate-to-severe acute post-operative pain, neurotoxicradio or chemotherapy and psycho-social factors.

CPSP has a multifactorial aetiology, principally nerve injury andwound inflammatory response, leading to peripheral and centralsensitisation.

The extent of wound hyperalgesia following abdominal surgerycorrelates with the incidence of CPSP but not with acute painoutcomes, reflecting the relative importance of central sensitisationin the development of CPSP.

The contributions of genetics, gender, age, opioid-inducedhyperalgesia, pre-existing pain disorders and psycho-social factorsto the pathogenesis of CPSP have yet to be clarified.
http://www.acutepainjournal.com/article/S1366-0071(06)00034-9/abstracthttp://www.acutepainjournal.com/article/S1366-0071(06)00034-9/abstracthttp://www.acutepainjournal.com/article/S1366-0071(06)00034-9/abstract


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CPSP-PREVENTION

The prevention of CPSP includes limiting nerve and tissueinjury and in some cases using preventive analgesiatechniques such as

regional neural blockade or low-dose ketamine infusion.

Other strategies such as education, patient surveillance,management of psycho-social factors and functionalrehabilitation may also be beneficial, although there are nodata to support this.

Further research is required to develop predictive tools

and to examine the effects of multimodal protectiveanalgesia and multidisciplinary approaches in theprevention and treatment of CPSP.


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MYOFASCIAL PAIN

Myofascial pain at post-sternotomy patients after cardiacsurgery: A clinical study in 1226 patients - Nurettin L.et.al Turkey

Conclusion: As a conclusion, the formation of trigger point in uppertrapezius and pectoralis major muscles in patients going underCABG with LIMA is 31.9% in patients postoperatively. We believethe reason for this incident is the graft harvesting of the internalmammary artery. Besides we believe that there is a parallel relationbetween the operation duration and trigger point formation, andmore prospective studies are needed to state the relation betweenthe formation of trigger points and the duration of the CABG.


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POST CABG PAIN A 61-year-old woman underwent coronary intervention via the right radial

artery for the treatment of unstable angina leading to complex regional painsyndrome II (CRPS type II) in the hand.

Pt. had serious regional pain with disability. After the operation shecomplained of severe pain in the right hand, consistently felt along the

median nerve distribution.

The nerve conduction study suggested carpal tunnel syndrome.

Stellate ganglion blockade, Cervical epidural blockade, and administration

of amitriptyline and loxoprofen.

The median nerve appeared to be damaged by local compression andpotential ischemia.


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POST CABG PAIN-Post Op Pain

Treatment options

Regional-Thoracic Epidural, Paravertebralblock Intercostal Nerve Block

Intrapleural Analgesia Local infiltration


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TREATMENT OPTIONS

PHARMACOLOGICAL

INTERVENTIONAL


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PHARMACOLOGICAL-ROUTES

IM/ IV SUBCUTANEOUS

TRANSDERMAL SULINGUAL RECTAL


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MEDICATIONS

ANALGESIC- Narcotics, Non narcotics Anticonvulsants

Antidepressnts


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KELOIDS
http://www.google.com/imgres?imgurl=http://www.skincare-answers.com/images/keloid_scar.jpg&imgrefurl=http://www.skincare-answers.com/skincare-acne-scar-treatment.html&usg=__h5Dr2ZWft13MXFt_3AKl8SS1sxw=&h=288&w=198&sz=8&hl=en&start=17&um=1&itbs=1&tbnid=7u9g2AsjTkTKUM:&tbnh=115&tbnw=79&prev=/images?q=keloid+after+cardiac+bypass+surgery&tbnid=Yn6v331pcHbBvM:&tbnh=0&tbnw=0&um=1&hl=en&sa=X&rlz=1T4TSNA_en___US377&ndsp=20&imgtype=i_similar&tbs=isch:1


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Baheti CABG Pain

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