A single-center retrospective observational cohort study on postoperative pain management: better with single or continuous doses of opiates or acetaminophen?

Abstract

Background: Proper pain management after cardiac surgery is essential for the prevention of postoperative complications, and several protocols have been proposed in this regard. The continuous administration of an opioid is a common approach now because it allows for more prolonged post-surgical analgesic effects. However, this method has several problems, such as the incidence of protracted delirium, nausea, and vomiting. The present study aims to evaluate the effects of two opioid administration methods on postoperative pain management and other clinical outcomes after cardiac surgery. Methods: This is a retrospective observational cohort study that enrolled 184 adult patients who underwent elective cardiac surgery. After ICU admission, patients were divided into two groups: 101 patients who received a single administration of fentanyl (25 mg boluses and a 30 min lockout time) and an administration of acetaminophen (l5 mg kg-1 and a 6 hour lockout time) [group S] and 83 patients who underwent continuous administration of fentanyl (25 mg hour-1 with 35 mg boluses and a 30 min lockout time) and an administration of acetaminophen (l5 mg kg-1 and a 6 hour lockout time) [group C]. For all patients, the Intensive Care Delirium Screening Checklist (ICDSC) scores were measured soon after extubation (0 hours) and 12, 24, and 36 hours later. Similarly, for all patients, NRS scores were also quickly measured after extubation (0 hours) and 8, 16, and 24 hours later. Results: ICDSC scores in group S were significantly lower than those in group C 0 and 12 hours after extubation (p < 0.001). However, ICDSC scores 24 and 36 hours post extubation did not differ significantly between the two groups. NRS scores did not differ significantly between the two groups until 24 hours after extubation. Conclusions: Compared with single administration of fentanyl with acute administration of acetaminophen, continuous administration of postoperative fentanyl with acute administration of acetaminophen may lead to increased risk for postoperative delirium. Therefore, acute administration of fentanyl may be preferable for continuous use in postoperative cardiac surgery patients.