title: Effect of sternal closure with biological bone adhesive on pain visual analogue score and serum cytokine.
abstract: OBJECTIVE
  Recently a biocompatible bone adhesive was introduced in addition to the sternal wires to expedite sternal union and improve patient recovery. In this study we aim to objectively assess the biomarker of pain in patient who received the biocompatible bone adhesive.
  
  
  METHODS
  A total of 62 patients who underwent sternotomy were prospectively randomised to receive either conventional wire closure (CWC); 32 patients or adhesive enhanced closure in addition to sternal wire (AEC); 30 patients. Patients were monitored postoperatively at certain time intervals for incisional pain, serum Interleukin-6 (IL-6) level, analgesia used and postoperative complications. All patients were followed up for 4 weeks.
  
  
  RESULTS
  The post-operative pain scores with coughing were significantly higher in the CWC group at 24 hours and 48 hours. The postoperative IL 6 levels were significantly higher in the CWC group in comparison with the AEC group at 6 hours, 24 hours, and 48 hours. There were no significant differences in term of additional analgesia used. No adverse events from adhesive bone cement were observed during follow up.
  
  
  CONCLUSIONS
  Adhesive-enhanced sternal closure resulted in modest reduction of pain confirmed by reduction of pain biomarker. Justification of its routine use requires larger multicentre study.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia. hashim.shahrul@yahoo.com.my.
authors.forename: Shahrul
authors.initials: S
authors.lastname: Hashim
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia. y_chin1981@yahoo.com.
authors.forename: Leow Yeen
authors.initials: LY
authors.lastname: Chin
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia. sivakumar@um.edu.my.
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Krishnasamy
authors.affiliation: Department of Pathology, University Malaya, 50603, Kuala Lumpur, Malaysia. pavai@um.edu.my.
authors.forename: Pavai
authors.initials: P
authors.lastname: Sthaneswar
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia. ramin@um.edu.my.
authors.forename: Raja Amin
authors.initials: RA
authors.lastname: Raja Mokhtar
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001864:Bone Wires; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D016037:Single-Blind Method; D056346:Sternotomy; D013249:Sternum / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D001843:Bone Cements; D015850:Interleukin-6