Perioperative pain management in cardiac surgery: a systematic review

Persistent Pain After Cardiac Surgery: Prevention and Management

“…26 The application of multimodal analgesics may play particular importance in preventing PPP as this more inclusive approach has been described as providing optimal acute pain management with potentially fewer side effects when compared with a traditional opioid-based strategy. 9,15,16,24 Acetaminophen, gabapentinoids, and ketamine have all been previously described as providing both effective analgesia and offering opioid-sparing benefit. 27,28 Rafiq and colleagues conducted a prospective randomized controlled trial (RCT) examining multimodal analgesics versus opioids following cardiac surgery through median sternotomy.…”

“…27,30 A subsequent systematic review conducted by Bignami and colleagues examined perioperative pain management modalities and cardiac surgery including multimodal analgesics. 16 With regard to acetaminophen (paracetamol) administration, the authors found 2 of 4 RCTs demonstrating significantly decreased Visual Analogue Scale (VAS) scores and one of these publications demonstrating significantly decreased opioid consumption. 16,[31][32][33][34] Of 3 RCTs examining nonsteroidal anti-inflammatory drug (NSAID) analgesics and cardiac surgery, 2 trials demonstrated decreased VAS, and opioid consumption with NSAID use.…”

“…43 Neuraxial anesthesia serves as one regional technique that may be considered in cardiac surgery via thoracic epidural analgesia (TEA) or spinal anesthesia. 16,43,44 TEA has been shown to provide effective analgesia with decreased VAS scoring and reduced opioid consumption postoperatively, 16,27 yet no evidence supports a definitive decrease in developing chronic pain following TEA or intrathecal opioid administration. 27 The risk of spinal hematoma has historically been shown to be 1:1528 for TEA and 1:3610 for spinal anesthesia, 45 but the risk for TEA has more recently been shown to be as low as 1:3552.…”

“…47 The decision to employ neuraxial anesthesia as part of any opioid-reducing analgesic strategy should always consider a risk-benefit calculation regarding epidural hematoma formation in the vulnerable cardiac surgery patient population. 9,16,43,48,49 Thoracic paravertebral block (PVB) serves as alternative regional anesthetic technique utilized for analgesia related to cardiac surgery. Thoracic PVB consists of a type of peripheral nerve block with option for continuous catheter placement similar to TEA, yet PVB may be performed under direct ultrasound guidance.…”

The Analgesic Efficacy of Ultrasound-guided Bilateral Transversus Thoracic MusclePlane Block after Open-Heart Surgeries: A Randomized Controlled Study

“…(1) Intolerable postoperative pain is debilitating and may lead to many adverse outcomes, including; respiratory problems, reduced mobilization, anxiety, impaired immune response, mood instability, postoperative delirium, and an increased mortality rate. (2) Postoperative pain management was dependent mainly on opioids, but the optimal results couldn't be achieved due to opioid-related side effects. (3) The multimodal analgesic technique has emerged to avoid these adverse effects of opioids and achieve appropriate analgesia; one of its components is fascial plane blocks.…”