Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study

Abstract

Background:Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG) surgery, as a component of multimodal analgesia (MMA) technique.Methods:This open observational prospective study comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS). The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs) starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm2 sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test.Results:The mean (standard deviation [SD]) VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94) while on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000). Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] – 6.38 [0.868]) at 24th h. After receiving the 2nd dose of laser the VRS scores fell significantly (P = 0.000) and became 0 at 54th h. No patients required 3rd dose of the laser. No patient required rescue analgesic while on laser therapy.Conclusion:Class IV laser can be an effective technique for postoperative analgesia following OPCABG surgery through sternotomy when included as a component of MMA technique.

The Effects of Photobiomodulation Therapy on Post-Surgical Pain

“…9 LLLT is a non-invasive method with approximately no side effects and its cost is more reasonable. Previous studies have documented various mechanisms for the efficacy of laser on pain relief, including photobiomodulation, which caused certain reactions such as increased production of ATP, prostaglandins 34,35 and beta-endorphins, decreased bradykinin levels, inhibition signal transduction from type C fibers, 32 and increased secretion of pain relief neurotransmitters such as serotonin. 36 In addition, LLLT can increases blood circulation, thus increases oxygen available for tissues and the pain-causing factors are diverted.…”

“…The results of 8 other studies that were studied in this review showed that LLLT was effective in reducing postoperative pain in patients with breast augmentation surgery, 26 inguinal hernia surgery, 27 tonsillectomy, 28,31 episiotomies, 29 tibial fracture surgery 24 and coronary artery bypass surgery. 32,33 In addition, the laser can reduce the use of pain relief medication, thus protecting the patient from the complications of these drugs.…”

“…Karlekar 32 (2015) n=100 Age ≥18 y -Patients who had candidate for coronary artery bypass graft through sternotomy.…”

“…The effect size was only calculated in 4 papers, 24,25,29,31 and in other articles due to the absence of SD or VAS, was not calculated. [26][27][28]30,32,33 As well, in Santos et al 29 VAS measurement was performed twice; more than 2 hours after surgery, and after 40-48 hours after surgery. Therefore, one of these measurements was used to determine the treatment effect size.…”

Low-intensity laser (660 NM) has analgesic effects on sternotomy of patients who underwent coronary artery bypass grafts

“…[ 24 ] and Karlekar et al . [ 25 ] and could support the higher influence of affective aspects on the McGill scores when applied to postoperative cardiac patients.…”