Reducing Opioid Use in Patients Undergoing Cardiac Surgery - Preoperative, Intraoperative, and Critical Care Strategies

Jason Ochroch, Asad Usman, Jesse Kiefer, Danielle Pulton, Ro Shah, Taras Grosh, Saumil Patel, William Vernick, Jacob T Gutsche, Jesse Raiten, Jason Ochroch, Asad Usman, Jesse Kiefer, Danielle Pulton, Ro Shah, Taras Grosh, Saumil Patel, William Vernick, Jacob T Gutsche, Jesse Raiten

Abstract

Patients undergoing cardiothoracic surgery are exposed to opioids in the operating room and intensive care unit and after hospital discharge. Opportunities exist to reduce perioperative opioid use at all stages of care and include alternative oral and intravenous medications, novel intraoperative regional anesthetic techniques, and postoperative opioid-sparing sedative and analgesic strategies. In this review, currently used and investigational strategies to reduce the opioid burden for cardiothoracic surgical patients are explored.

Keywords: cardiac surgery; early recovery after surgery; extracorporeal membrane oxygenation; fast-track cardiac surgery; opioid-free analgesia; opioid-sparing surgery; sedation.

Conflict of interest statement

Conflicts of Interest

The authors have no conflicts of interest to declare.

Copyright © 2020 Elsevier Inc. All rights reserved.

Figures

Fig 1.
Fig 1.
Non-opioid analgesics commonly used in perioperative cardiac surgery. COX, cyclooxygenase; NMDA, N-Methyl-D-aspartate; NSAID, nonsteroidal anti-inflammatory drug.
Fig 2.
Fig 2.
Fast-track cardiac surgery protocol used at the University of Pennsylvania, Department of Anesthesiology and Critical Care. CABG, coronary artery bypass grafting; IV, intravenous; OR, operating room; POD, postoperative day.
Fig 3.
Fig 3.
Regional anesthesia techniques in cardiac surgery. PEC, pectoralis nerve block.

Source: PubMed

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