Background and Aims Sternal resection for selected patients with hemotogenous solitary sternal metastases by breast cancer might provide good long-term local control.Chronic post-thoracotomy pain is a serious and underrated condition warranting a continuing active pain management after discharge from hospital.A perioperative multimodal opioid sparing strategy for pain management after sternum resection and chest wall reconstruction due to metastasis is presented.
Methods A 53-year-old woman was scheduled forresection of manubrium of the sternum and chest wall reconstructionafter diagnosis of a solitary sternal metastasis. The patient had a history of bilateral mastectomy for breast cancer 10 years earlier.Sternal defect was filled with an implant made of polyethylene.
Results A multimodal perioperative opioid sparing strategy resulted in adequate postoperative pain control. Follow up of the patient at 2 weeks, 1,2,3,6 ,9 months and one year revealed a localized dysesthesia and aching area under the clavicles. No other complications were noted, and the patient has returned to daily activities and work. Ahigh level of satisfaction from adequate pain control was reported.
Conclusions Reconstruction procedures after sternum resection are difficult and burdened with significant complications including chronic pain development. A careful perioperative multimodal pain management strategy tailored to patients needs and wishes can prevent chronic pain development. The challenge is to identify patients at high risk of developing persistent post-thoracotomy pain and to create a targeted care pathway to ensure effective and safe pain treatment especially in the subacute postoperative phase at home.
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