Investigation of the effect of sternum retractor opening distance on postoperative pain in cardiac surgery operations performed with median sternotomy

Hakan Özçelik, Mesut Engin, Orhan Güvenç, Ufuk Aydın, Yusuf Ata, Miktat Arif Haberal, Şenol Yavuz

Abstract

Objectives: Pain that develops after cardiac surgery can negatively affect early recovery. In this study, we aimed to investigate the effect of sternal retractor opening on post-sternotomy pain in cardiac surgeries performed with median sternotomy.
Methods: Patients who underwent open cardiac surgery with median sternotomy in our clinic between September 2023 and March 2025 were included in this retrospective study. Postoperative pain assessments were performed using the Visual Analogue Scale (VAS) at the 2nd hour (VAS0), 6th hour (VAS1), first day (postoperative 24th hour) (VAS2), and second day (postoperative 48th hour) (VAS3) after extubation. Patients were divided into two groups: those with sternum retractor opening less than 9 cm (Group 1) and those with 9 cm or more (Group 2).
Results: A total of 124 patients were included in the study. The mean age of the patients was 59.8 ± 14.2 years (range: 19–81), and 67 (54%) patients were female. As a result of the analysis, a statistically significant difference was found between the groups only in VAS0 values. While the median VAS0 value was 4 (range: 0–10) in Group 1, it was found to be 6 (range: 0–10) in Group 2 (P = 0.033). Although VAS1, VAS2, and VAS3 values were higher in Group 2, there was no statistically significant difference (P values: P = 0.132, P = 0.421, P = 0.267, respectively).
Conclusions: Although there was no statistically significant difference in the pain evaluations at the sixth postoperative hour, on the first day, and on the second day, we found that patients with smaller retractor openings had lower pain scores.