title: Subxiphoid versus intercostal chest tubes: comparison of postoperative pain and pulmonary morbidities after coronary artery bypass grafting.
abstract: Chest tubes are one cause of pain after cardiac surgery. In a prospective, randomized study, we investigated the effects of the position of chest tubes on acute postoperative pain and pulmonary morbidities in patients who underwent coronary artery bypass grafting. From June through December 2010, 40 patients who underwent elective coronary artery bypass grafting were enrolled in the study. We investigated 2 randomized groups of patients: Group 1 (n-20) had a left chest tube inserted through the midline inferior to the xiphoid process (subxiphoid approach), and Group 2 (n-20) had a left chest tube inserted through the 6th intercostal space along the anterior axillary line (intercostal approach). We compared the results with respect to postoperative pain, the need for analgesic agents, chest-tube drainage, pulmonary morbidities, and duration of hospitalization. The intensity of postoperative pain was similar between the groups. The cumulative doses of analgesic agents, incidence of pulmonary morbidities, and duration of hospitalization were also similar. Pleural effusion and atelectasis were each diagnosed in 3 patients in Group 1 (15%) and 1 patient in Group 2 (5%) (both P=0.68). Two of the patients in Group 1 required drainage of the pleural effusion. In our study, we found that the subxiphoid and intercostal approaches for chest-tube placement yielded similar clinical outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Istanbul Sema Hospital, 34844 Istanbul, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Guden
authors.forename: Askin Ali
authors.initials: AA
authors.lastname: Korkmaz
authors.forename: Burak
authors.initials: B
authors.lastname: Onan
authors.forename: Ismihan Selen
authors.initials: IS
authors.lastname: Onan
authors.forename: Sevim Indelen
authors.initials: SI
authors.lastname: Tarakci
authors.forename: Fatma
authors.initials: F
authors.lastname: Fidan
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D015505:Chest Tubes; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation*; D017558:Elective Surgical Procedures; D004867:Equipment Design; D005260:Female; D006801:Humans; D007902:Length of Stay; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010996:Pleural Effusion / Q000209:etiology; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014421:Turkey
chemical_list: D000700:Analgesics