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Ann Thorac Surg 2000;69:1455-1458
© 2000 The Society of Thoracic Surgeons

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Original articles: Cardiovascular

Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft

^a Comprehensive Pain Program, Toronto General and Toronto Western Hospitals, Toronto, Ontario, Canada
^b Playfair Neuroscience Unit, Toronto General and Toronto Western Hospitals, Toronto, Ontario, Canada
^c Division of Cardiovascular Surgery, Toronto General and Toronto Western Hospitals, Toronto, Ontario, Canada
^d University of Toronto Centre for the Study of Pain, Toronto, Ontario, Canada

Address reprint requests to Dr Mailis, Comprehensive Pain Program, Toronto Western Hospital, University Health Network, 4BFell-174, 399 Bathurst St, Toronto, ON, Canada M5T 2S8
e-mail: angela.mailis{at}uhn.on.ca

Background. The prevalence of intercostal nerve damage associated with coronary artery bypass graft–internal thoracic (mammary) artery surgery is unknown.

Methods. A total of 37 consecutive patients with coronary artery bypass graft surgery (all with left internal thoracic artery graft) who were attending a cardiac-related exercise program underwent a thorough examination. Nerve damage was considered to be "definite" in the presence of two consistent and well-demarcated sensory abnormalities over the anterior chest wall within the T1 to T6 anterior intercostal nerve territory, and was considered "possible" in the presence of one such abnormality.

Results. Definite nerve damage was detected in 73% of the subjects, and possible nerve damage was found in another 11% at the site of internal thoracic artery harvesting. Protracted postoperative pain or unpleasant sensations, usually subsiding by 4 months, were reported by recollection by 81% of the subjects. Overall, the prevalence of persistent pain in those with definite nerve damage 5 to 28 months after surgery was 15%.

Conclusions. Intercostal nerve damage seems to occur in three-quarters of all patients undergoing coronary artery bypass graft–internal thoracic artery surgery. A significant minority may continue to experience bothersome chronic chest wall pain.

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