Comparison of MIDCAB Versus Conventional CABG Surgery Regarding Pain and Quality of Life

(#1999-32610 ... August 19, 1999)

Anno Diegeler, Thomas Walther, Sebastian Metz, Volkmar Falk, Ralf Krakor, Rüdiger Autschbach, Friedrich Wilhelm Mohr

Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig

ABSTRACT

Background: This prospective clinical trial focuses on pain and quality of life (QOL) after minimally invasive direct coronary artery bypass (MIDCAB) grafting versus conventional coronary artery bypass grafting (CABG).

Materials and Methods: Group A consisted of 65 consecutive MIDCAB patients using an anterolateral mini-thoracotomy and the "off-pump" technique. Group B consisted of 95 computer-matched patients who underwent conventional CABG with cardiopulmonary bypass (CPB). Pain was graduated using the visual analog scale (VAS), and the verbal rating scale (VRS) [Troidl 1990]. QOL was evaluated at the time of discharge and three months after surgery using modified Nottingham Health Questionnaires that separate physical, social, activity, emotional, pain, and sleeping conditions.

Results: Postoperative pain was higher after MIDCAB on postoperative day (POD) 1 (p< 0.002). From POD 4 onwards MIDCAB patients had less pain compared with the conventional group (p<0.04). MIDCAB patients required less pain medication from POD 4 onwards (p<0.05). QOL was significantly better in the MIDCAB group on POD 7 for physical (p< 0.038), activity (p< 0.016), pain (p< 0.041), and sleep (p<0.038) conditions. The three-month questionnaire showed significantly better levels for MIDCAB patients regarding physical (p< 0.03) and pain (p< 0.001) conditions, and a trend for activity (p< 0.08) and emotional (p<0.08) conditions.

Conclusion: Compared to patients undergoing conventional surgery, MIDCAB patients suffer more pain in the first three postoperative days, probably as a result of the lateral thoracotomy. From POD 4 onwards, MIDCAB patients are significantly better, experiencing less pain and showing better physical, activity, and sleeping conditions even three months after surgery. This can be attributed to the absence of median sternotomy and/or the avoidance of cardiopulmonary bypass.

AUTHOR/ARTICLE INFORMATION

Reprint requests to: Anno Diegeler MD, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Russenstrasse 19, 04289 Leipzig, Germany

Submitted on: August 17, 1999; Accepted on: August 19, 1999

Keywords: pain, quality of life, minimally invasive cardiac surgery, scoring systems