The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review

Brenda Nachiyunde, Louisa Lam, Brenda Nachiyunde, Louisa Lam

Abstract

Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4-6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24-72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.

Keywords: cardiac surgery; cardiothoracic intensive care; critical care; intensive care unit; local anesthetic subcutaneous infusions; meta-analyses; open heart surgery; pain; pain busters; pain guidelines; pain protocols; paravertebral blocks; patient-controlled analgesia; postcardiac surgery; randomized controlled trials; sternotomy; “Pain” management.

Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1
Figure 1
Pain management post cardiac surgery. Flowchart describing the search criteria
Figure 2
Figure 2
Verbal analog scores for pain at rest (a) and with cough (b) on a standard 0 to 10 scale over the first 24 h after surgery. Values are a mean ± standard deviation. (McDonald et al. 2005)[16]
Figure 3
Figure 3
Consumption of patient-controlled analgesia Morphine in the 12 h period (Barr et al.)

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