[Chest pain in a patient after median sternotomy]

A 62-year-old woman presented with a 1-year history of painful operative scar following median sternotomy performed for coronary artery bypass grafting at another hospital shortly after myocardial infarction. She had a 5-year history of diabetes mellitus, which had been controlled with diet therapy. There were no abnormalities in electrocardiographic or cardiac function. She complained of burning pain and marked tenderness bilaterally in the parasternal region. There were no abnormal laboratory findings. No fractures were detected in the ribs or sternum radiographically. Her chest pain was not alleviated by analgesics including nonsteroidal anti-inflammatory agents or tricyclic antidepressants. Neither local anesthesia nor thoracic epidural anesthesia was effective in eliminating her pain. Slight relief was obtained by heating with infrared radiation, but the duration of pain relief was very short. This patient's findings indicate that painful operative scar should be considered as a potentially serious complication of surgery requiring median sternotomy.