Patients know that for most heart operations a substantial incision with division of the breast bone (sternum) is needed in the middle of the chest. This incision is nearly one and a half times that of a caesarean section. We know of women begging for a Caesarean operation in preference to a normal labour. There is no fear of a caesarean section; while people continue to be mortally scared of bypass which is often a life saving procedure!
It is almost necessary to divide the sternum (breast bone) to perform heart operations. And a common perception amongst the common people is that division of the sternum must be very painful.
Most painful incisions in the body are as follows:-
- Postero-lateral thoracotomy, as for operations for lungs.
- Lower abdominal incisions as for Caesarean sections
- Lumbar incisions as for Kidney operations
- Midline abdominal incisions as for Stomach, small and large bowel operations
- Midline sternotomy as for heart operations
Midline sternal incisions are less painful than the caesarean or kidney incisions.
Most importantly the degree of pain one has to endure after surgery depends upon the sensitivity of the treating doctors and nurses towards pain management. It is essential that all patients receive 4-8 tablets per day of paracetamol (500mg). This provides background pain relief. Younger heart patients can often receive non-steroidal drugs like diclofenac/ ibuprofen in the absence of contraindications. Older heart patients should not normally receive these drugs because of concerns regarding kidney function. All patients could receive additional ‘atypical narcotics’ like tramadol or ‘typical narcotics’ like morphine or fentanyl. All patients must continue to take regular pain medication with additional allowances in the case of breakthrough pain (pain that comes on despite regular meds).
If a patent takes painkillers only when they suffer pain, they suffer unduly, pain control is poorer and they often consume much larger doses in total per day.
- Pain after heart surgery is not as severe as believed.
- It is not due to lack of medications that some patients suffer pain, but often due to lack of sensitivity of the treating team towards pain and bravado amongst the patients who wish to claim victory over pain.
- Patients must ask for additional painkillers (if in an insensitive environment) and not suffer in silence.
- Postoperative pain lasts a few weeks and pain killers must be continued till then, in reducing doses as per reduction in pain.
- All patients differ with regards to their dosage requirement and it is best to educate the patients in such a way that they can self manage their painkillers.