Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment

Roca, Jordi; Valero, Rosendo; Gomar, C

doi:10.1016/j.redare.2017.05.005

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…We are beginning to recognize that pain peaks and declines at different rhythms (Mori et al, 2021). The location of the pain in the body shifts from the sternotomy site to the sides of the chest and then to the neck, and to the back, where it becomes more musculoskeletal in nature (Roca et al, 2017). More studies are necessary to explain this further.…”

Section: Discussionmentioning

confidence: 99%

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Galao-Malo,

Davidson,

D'Aoust

et al. 2024

J Am Assoc Nurse Pract

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Background: Deaths related to overdoses continue growing in the United States. The overprescription of opioids after surgical procedures may contribute to this problem. Local problem: There is inconsistency in the prescription of opioids in cardiovascular surgery patients. Recommendations regarding the reduction of opioids at discharge are not fully implemented. Methods: This is a single-center, pre–post quality improvement project in adult patients after elective cardiac surgery through sternotomy. Interventions: Changes in guidelines, modification of order sets, creation of dashboards, and education to the providers to increase the prescription of acetaminophen around the clock on the step-down unit and at discharge, decrease the number of opioid tablets to 25 or less at discharge and decrease the prescription of opioids to 25 or less morphine milligram equivalents (MME) at discharge. Results: The preintervention group included 67 consecutive patients who underwent cardiac surgery from November to December 2021. The postintervention group had 67 patients during the same period in 2022. Acetaminophen prescription on the step-down unit increased from 9% to 96% (p < .001). The proportion of patients discharged with 25 or less opioid tablets increased from 18% to 90% (p < .001) and with 25 or less MME from 30% to 55% (p < .01). Acetaminophen prescription at discharge increased from 10% to 48% (p < .001). Conclusions: Our intervention increased the use of acetaminophen and decreased the overprescription of opioids in cardiac surgery patients at discharge. Further research is necessary to continue improving pain management to reduce the number of opioids prescribed at discharge.

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Section: Discussionmentioning

confidence: 99%

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Galao-Malo,

Davidson,

D'Aoust

et al. 2024

J Am Assoc Nurse Pract

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“…Postoperative pain is most intense during the first 24 hours and sternotomy is frequently reported as the most painful area after cardiac surgery. [20][21][22][23] Transversus thoracis muscle plane block (TTPB) is an ultrasound (US)-guided anterior chest wall fascial plane block. It blocks multiple anterior branches of intercostal nerves (Th2-6) which innervate the sternum area.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Single-centre, double-blind, randomised, parallel-group, superiority study to evaluate the effectiveness of general anaesthesia and ultrasound-guided transversus thoracis muscle plane block combination in adult cardiac surgery for reducing the surgical stress response: clinical trial protocol

et al. 2021

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IntroductionAdult open-heart surgery is a major surgery that causes surgical stress response and activation of the immune system, contributing further to postoperative complications. Transversus thoracis muscle plane block (TTPB) may potentially benefit in reducing the surgical stress response. This study aims to know the effectiveness of preoperative TTPB in adult open-heart surgery for reducing the surgical stress response.Methods and analysisThis study is a prospective, double-blind, randomised control trial comparing the combination of general anaesthesia and TTPB versus general anaesthesia only in adult open-heart surgery. Forty-two eligible subjects will be randomly assigned to the TTPB group or control group. The primary outcomes are the difference between the two groups in the means of postoperative cortisol and interleukin-6 plasma levels at 24 hours and 48 hours after cardiac intensive care unit admission. The secondary outcomes are the difference between the two groups in the means of total 24-hour postoperative morphine consumption and time of first postoperative patient-controlled analgesia (PCA) dose.Ethics and disseminationThe study protocol and informed consent forms have been reviewed and approved by the Ethics Committee of Faculty of Medicine Universitas Indonesia/Dr. Cipto Mangunkusumo Hospital. The result will be released to the medical community through presentation and publication in peer-reviewed journals.Trial registration numberNCT04544254.

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“…Pain after cardiac surgery is common, occurring as a direct result of surgical manipulation and indirectly due to activation of inflammatory pathways [1,2]. Beyond the goal of patient comfort, early postoperative pain control is thought to decrease the likelihood of developing chronic poststernotomy pain syndrome, a syndrome which otherwise is reported to occur in up to one third of patients undergoing cardiac surgery [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Regional anesthesia techniques for cardiac surgery: where are we?

Kim

Gonzalez-Ciccarelli²,

Brovman³

2022

Current Opinion in Anaesthesiology

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Purpose of reviewInadequate pain relief after cardiac surgery results in decreased patient experience and satisfaction, increased opioid consumption with its associated adverse consequences, and reduced efficiency metrics. To mitigate this, regional analgesic techniques are an increasingly important part of the perioperative cardiac anesthesia care plan. The purpose of this review is to compare current regional anesthesia techniques, and the relative evidence supporting their efficacy and safety in cardiac surgery. Recent findingsNumerous novel plane blocks have been developed in recent years, with evidence of improved pain control after cardiac surgery.

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Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment

Cited by 4 publications

References 18 publications

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Implementing an evidence-based guideline to decrease opioids after cardiac surgery

Single-centre, double-blind, randomised, parallel-group, superiority study to evaluate the effectiveness of general anaesthesia and ultrasound-guided transversus thoracis muscle plane block combination in adult cardiac surgery for reducing the surgical stress response: clinical trial protocol

Regional anesthesia techniques for cardiac surgery: where are we?

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