Abstract

Objectives. Mediastinal chest tubes are considered to be a significant factor causing postoperative pain after cardiac surgery. The aim of the study was to ascertain whether the duration of mediastinal drainage is associated with postoperative pain and opioid consumption. Design. A total of 468 consecutive patients undergoing cardiac surgery at the Tampere University Hospital between December 2015 and August 2016 were retrospectively analyzed. The first 252 patients were treated according to short and the following 216 patients according to extended drainage protocol, in which the mediastinal chest tubes were habitually removed on the first and second postoperative day, respectively. The oxycodone hydrochloride consumption, as well as daily mean pain scores assessed by numeric/visual rating scales, were compared between the groups. Results. The mean daily pain scores and cumulative opioid consumption were similar in both groups. Patients with reduced ejection fraction, diabetes, and peripheral vascular disease reported lower initial pain scores. The median cumulative oxycodone hydrochloride consumption did not differ according to the drainage protocol but was higher in males, smokers, and after aortic surgery. In contrast, patients with advanced age, hypertension, and peripheral vascular disease had lower consumption. In multivariable analysis, male sex and aortic surgery were associated with higher and advanced age with lower opioid use. Conclusions. The length of mediastinal chest tube drainage is not associated with the amount of postoperative pain or need for opioids after cardiac surgery. Male sex and aortic surgery were associated with higher and advanced age with lower overall opioid consumption.

摘要

目标。纵隔胸管被认为是心脏手术后引起术后疼痛的重要因素。该研究的目的是确定纵隔引流的持续时间是否与术后疼痛和阿片类药物消耗有关。设计。回顾性分析了 2015 年 12 月至 2016 年 8 月期间在坦佩雷大学医院接受心脏手术的 468 名连续患者。前 252 例患者采用短引流方案，随后 216 例患者采用延长引流方案，分别在术后第一天和第二天习惯性地拔除纵隔胸管。在各组之间比较盐酸羟考酮消耗量以及通过数字/视觉评定量表评估的每日平均疼痛评分。结果。两组的平均每日疼痛评分和累积阿片类药物消耗量相似。射血分数降低、糖尿病和外周血管疾病的患者报告初始疼痛评分较低。根据引流方案，盐酸羟考酮累积消耗量中位数没有差异，但男性、吸烟者和主动脉手术后更高。相比之下，高龄、高血压和外周血管疾病患者的消费量较低。在多变量分析中，男性和主动脉手术与阿片类药物使用率较低的高龄和高龄相关。结论。纵隔胸管引流长度与术后疼痛程度或心脏手术后对阿片类药物的需求无关。男性和主动脉手术与较高和较高年龄相关，总体阿片类药物消耗较低。