Is it normal to have post-operative right chest pain and warmth at the incision site 4 weeks after a right thoracotomy for cardiac surgery, without signs of inflammation or redness?

From the Guidelines

It is normal to experience right chest pain and warmth at the incision site 4 weeks after a right thoracotomy for cardiac surgery, especially when there are no signs of inflammation or redness. Post-operative pain and sensations can persist for several weeks to months after cardiac surgery as the tissues, muscles, and nerves continue to heal. The healing process involves nerve regeneration and scar tissue formation, which can cause sensations of warmth, tightness, numbness, or pain. According to the most recent guidelines, such as the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain 1, post-sternotomy pain syndrome is a common condition that can occur after thoracic surgery, with an incidence ranging from 7% to 66%. For pain management, you can take over-the-counter pain medications like acetaminophen (Tylenol) 500-1000mg every 6 hours as needed, not exceeding 4000mg per day. Applying a heating pad on a low setting for 15-20 minutes several times daily may also help. Deep breathing exercises and gentle movement can aid recovery. However, if you develop new symptoms such as increasing pain, redness, swelling, discharge from the incision, fever above 100.4°F, or shortness of breath, contact your healthcare provider immediately as these could indicate complications like infection or other post-surgical issues. It's also important to note that the guidelines for the diagnosis and management of skin and soft tissue infections, such as those published by the Infectious Diseases Society of America 1 and 1, emphasize the importance of monitoring for signs of infection, such as purulent drainage, erythema, and swelling, but in this case, since there are no signs of inflammation or redness, the current symptoms can be considered normal.

From the Research

Post-Operative Pain and Warmth After Right Thoracotomy

• The presence of post-operative right chest pain and warmth at the incision site 4 weeks after a right thoracotomy for cardiac surgery, without signs of inflammation or redness, may be a complex issue to address.
• According to 2, most patients who undergo surgical procedures experience acute postoperative pain, but evidence suggests that less than half report adequate postoperative pain relief.
• The study 2 also highlights the importance of preoperative education, perioperative pain management planning, and the use of different pharmacological and nonpharmacological modalities in managing postoperative pain.
• Another study 3 notes that acute postoperative pain is common, with nearly 20 per cent of patients experiencing severe pain in the first 24 hours after surgery.
• However, the provided studies do not directly address the normalcy of post-operative pain and warmth at the incision site 4 weeks after a right thoracotomy.
• It is essential to consider that postoperative pain management is a multifaceted issue, and the presence of pain and warmth may be influenced by various factors, including the surgical procedure, individual patient characteristics, and the effectiveness of pain management strategies 2, 3.
• The study 4 on the safety profile of an intravenous acetaminophen/ibuprofen fixed dose combination may provide some insight into the management of postoperative pain, but it does not directly address the issue of post-operative pain and warmth at the incision site.
• Similarly, the study 5 on postoperative pain management using an intravenous combination of ibuprofen and acetaminophen compared with acetaminophen alone after thyroidectomy may offer some guidance on pain management, but its relevance to the specific issue of post-operative pain and warmth after a right thoracotomy is limited.
• The study 6 emphasizes the importance of physical examination in patient evaluation, but it does not provide specific information on post-operative pain and warmth after a right thoracotomy.

Potential Considerations

• The absence of signs of inflammation or redness may suggest that the pain and warmth are not due to an infectious process.
• However, it is crucial to consider other potential causes of post-operative pain and warmth, such as nerve damage, scar tissue, or other complications related to the surgical procedure.
• Further evaluation and monitoring by a healthcare professional may be necessary to determine the underlying cause of the post-operative pain and warmth and to develop an effective management plan.