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Median sternotomy optimizes CABG exposure; Level 5 evidence leaves open whether alternatives reduce complications without compromising visualization.
Coronary heart disease is a life threatening condition for human population. During surgical intervention like Coronary Artery Bypass Graft (CABG), median sternotomy is the best approach for a clear visualization of heart & associated viscera. Median sternotomy is a type of surgical procedure in which a midline vertical incision is made along the sternum after which the sternum itself is divided or cracked. 1 Cardiac procedure requiring median sternotomy includes coronary artery bypass grafting, valve replacement, repair of a variety of congenital cardiac diseases. Post-sternotomy pain is mostly musculoskeletal & myofascial. These painful conditions are jointly called post sternotomy pain syndrome 2 . Per-operatively it is controlled by large bolus intravenous infusion of opioid viz morphine or fentanyl. Thoracotomy, sternotomy and the placement of pleural chest tubes results in considerable pain in the post operative period in patients undergoing CABG 3 . Traditionally opioids and NSAID are used for post operative pain management after sternotomy.
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Hasan et al. (2011) studied this question.
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