Assessment and pathophysiology of pain in cardiac surgery

Marek Zubrzycki, Andreas Liebold, Christian Skrabal, Helmut Reinelt, Mechthild Ziegler, Ewelina Perdas, Maria Zubrzycka, Marek Zubrzycki, Andreas Liebold, Christian Skrabal, Helmut Reinelt, Mechthild Ziegler, Ewelina Perdas, Maria Zubrzycka

Abstract

Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.

Keywords: analgesics; cardiac surgery; pain intensity; postoperative pain.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Pain sensation process – nociception. Abbreviations: DRG, dorsal root ganglia; WDR, wide dynamic range.
Figure 2
Figure 2
Pain scales – assessment of pain intensity.
Figure 3
Figure 3
Prince Henry Hospital Pain Score.

References

    1. Mazzeffi M, Khelemsky Y. Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth. 2011;25(6):1163–1178.
    1. Steegers MA, Snik DM, Verhagen AF, van der Drift MA, Wilder-Smith OH. Only half of the chronic pain after thoracic surgery shows a neuropathic component. J Pain. 2008;9(10):955–961.
    1. Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–540.
    1. Cogan J. Pain management after cardiac surgery. Semin Cardiothorac Vasc Anesth. 2010;14(3):201–204.
    1. Vaughn F, Wichowski H, Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN J. 2007;85(3):589–604.
    1. Sasseron AB, Figueiredo LC, Trova K, et al. Does the pain disturb respiratory function after heart surgeries? Rev Bras Cir Cardiovasc. 2009;24(4):490–496.
    1. Freynhagen R, Baron R, Gockel U, Tölle TR. Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Curr Med Res Opin. 2006;22(10):1911–1920.
    1. Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934–944.
    1. Bjørnnes AK, Rustøen T, Lie I, Watt-Watson J, Leegaard M. Pain characteristics and analgesic intake before and following cardiac surgery. Eur J Cardiovasc Nurs. 2016;15(1):47–54.
    1. Darr C, Cheufou D, Weinreich G, Hachenberg T, Aigner C, Kampe S. Robotic thoracic surgery results in shorter hospital stay and lower postoperative pain compared to open thoracotomy: a matched pairs analysis. Surg Endosc. 2017;31(10):4126–4130.
    1. Fot EV, Izotova NN, Yudina AS, Smetkin AA, Kuzkov VV, Kirov MY. Automated weaning from mechanical ventilation after off-pump coronary artery bypass grafting. Front Med (Lausanne) 2017;4:31.
    1. Träger K, Fritzler D, Fischer G, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs. 2016;39(3):141–146.
    1. Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chioléro R, von Segesser LK. Pain location, distribution, and intensity after cardiac surgery. Chest. 2000;118(2):391–396.
    1. Kalso E, Mennander S, Tasmuth T, Nilsson E. Chronic post-sternotomy pain. Acta Anaesthesiol Scand. 2001;45(8):935–939.
    1. Gerbershagen HJ, Pogatzki-Zahn E, Aduckathil S, et al. Procedure-specific risk factor analysis for the development of severe postoperative pain. Anesthesiology. 2014;120(5):1237–1245.
    1. van Dijk JF, van Wijck AJ, Kappen TH, Peelen LM, Kalkman CJ, Schuurmans MJ. Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. Int J Nurs Stud. 2012;49(1):65–71.
    1. Rothaug J, Zaslansky R, Schwenkglenks M, et al. Patients’ perception of postoperative pain management: validation of the International Pain Outcomes (IPO) questionnaire. J Pain. 2013;14(11):1361–1370.
    1. Braun LA, Stanguts C, Casanelia L, et al. Massage therapy for cardiac surgery patients: a randomized trial. J Thorac Cardiovasc Surg. 2012;144(6):1453–1459.
    1. Hendrix H, Kamlak V, Prisadov G, Welcker K. Pain treatment after thoracic surgery. Zentralbl Chir. 2017;142(3):337–347. German.
    1. Mcmahon SR, Ades PA, Thompson PD. The role of cardiac rehabilitation in patients with heart disease. Trends Cardiovasc Med. 2017;27(6):420–425.
    1. Doenst T, Essa Y, Jacoub K, et al. Cardiac surgery 2016 reviewed. Clin Res Cardiol. 2017;106(11):851–867.
    1. Easterwood RM, Bostock IC, Nammalwar S, Mccullough JN, Iribarne A. The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches. Future Cardiol. 2018;14(1):75–87.
    1. Soylu E, Harling L, Ashrafian H, et al. A systematic review of the safety and efficacy of distal coronary artery anastomotic devices in MIDCAB and TECAB surgery. Perfusion. 2016;31(7):537–543.
    1. Kofler M, Schachner T, Reinstadler SJ, et al. Comparative analysis of perioperative and mid-term results of TECAB and MIDCAB for revascularization of anterior wall. Innovations (Phila) 2017;12(3):207–213.
    1. Roediger L, Larbuisson R, Lamy M. New approaches and old controversies to postoperative pain control following cardiac surgery. Eur J Anaesthesiol. 2006;23(7):539–550.
    1. Melidi E, Latsios G, Toutouzas K, et al. Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure. Hellenic J Cardiol. 2016;57(6):401–406.
    1. Bauernschmitt R, Bauer S, Liewald C, et al. First successful trans-catheter double valve replacement from a transapical access and nine-month follow-up. EuroIntervention. 2017;12(13):1645–1648.
    1. Sokoloff A, Eltchaninoff H. TAVI: history and perspectives. Presse Med. 2017;46(7–8 Pt 1):772–776. French.
    1. Kowalewski M, Pawliszak W, Malvindi PG, et al. Off-pump coronary artery bypass grafting improves short-term outcomes in high-risk patients compared with on-pump coronary artery bypass grafting: meta-analysis. J Thorac Cardiovasc Surg. 2016;151(1):60–77.
    1. Watt-Watson J, Stevens B. Managing pain after coronary artery bypass surgery. J Cardiovasc Nurs. 1998;12(3):39–51.
    1. Swarm RA, Karanikolas M, Kalauokalani D. Pain treatment in the perioperative period. Curr Probl Surg. 2001;38(11):835–920.
    1. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9(2):122–145.
    1. Yaksh T, Woller S, Ramachandran R, Sorkin L. The search for novel analgesics: targets and mechanisms. F1000Prime Rep. 2015;7:56.
    1. Mao J. Current challenges in translational pain research. Trends Pharmacol Sci. 2012;33(11):568–573.
    1. Moloney N, Rabey M, Nijs J, Hush J, Slater H. Support for extended classification of pain states. Pain. 2017;158(7):1395.
    1. Sorkin LS, Wallace MS. Acute pain mechanisms. Surg Clin North Am. 1999;79(2):213–229.
    1. Offner KA, Loop T. Pathophysiology and epidemiology of pain in thoracic surgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47(9):568–575. German.
    1. Pain terms: a list with definitions and notes on usage. Pain. 1979;6(3):249–252. No authors listed.
    1. Ergün A, Sirlak M. Pulmonary function test before and after operation of coronary artery by-pass surgery. Tuberk Toraks. 2003;51(1):17–22. Turkish.
    1. Shenkman Z, Shir Y, Weiss YG, Bleiberg B, Gross D. The effects of cardiac surgery on early and late pulmonary functions. Acta Anaesthesiol Scand. 1997;41(9):1193–1199.
    1. Roncada G, Dendale P, Linsen L, Hendrikx M, Hansen D. Reduction in pulmonary function after CABG surgery is related to postoperative inflammation and hypercortisolemia. Int J Clin Exp Med. 2015;8(7):10938–10946.
    1. Milgrom LB, Brooks JA, Qi R. Pain levels experienced with activities after cardiac surgery. Am J Crit Care. 2004;13(2):116–125.
    1. Bartoloni A, Polati E, Finco G, Facchin S, Rigo V, Gottin L. The neuroendocrine and metabolic responses to surgical stress. Chir Ital. 1995;47(6):3–11. Italian.
    1. Saito H. Endocrine response to surgical stress. Nihon Geka Gakkai Zasshi. 1996;97(9):701–707. Japanese.
    1. Malberg H, Wessel N, Kopp B, Bauernschmitt R. Analysis of cardiovascular regulation after heart operation. Biomed Tech. 2002;47(Suppl 1 Pt 2):541–542. German.
    1. Liu SS, Wu CL, Cl W. Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg. 2007;104(3):689–702.
    1. Schultz CH, Rivers EP, Feldkamp CS, et al. A characterization of hypothalamic-pituitary-adrenal axis function during and after human cardiac arrest. Crit Care Med. 1993;21(9):1339–1347.
    1. Karkouti K, Dattilo KM. Perioperative hemostasis and thrombosis. Can J Anaesth. 2006;53(12):1260–1262.
    1. Smit PJ, Shariff MA, Nabagiez JP, Khan MA, Sadel SM, McGinn JT. Experience with a minimally invasive approach to combined valve surgery and coronary artery bypass grafting through bilateral thoracotomies. Heart Surg Forum. 2013;16(3):E125–E131.
    1. Uymaz B, Sezer G, Coskun PK, Tarcan O, Ozleme S, Aybek T. Clinical outcome, pain perception and activities of daily life after minimally invasive coronary artery bypass grafting. Anadolu Kardiyol Derg. 2014;14(2):172–177.
    1. Gerner P. Postthoracotomy pain management problems. Anesthesiol Clin. 2008;26(2):355–367.
    1. Dualé C, Ouchchane L, Schoeffler P, et al. Neuropathic aspects of persistent postsurgical pain: a French multicenter survey with a 6-month prospective follow-up. J Pain. 2014;15(1):24.e1–e20.
    1. Buvanendran A, Kroin JS, della Valle CJ, Kari M, Moric M, Tuman KJ. Perioperative oral pregabalin reduces chronic pain after total knee arthroplasty: a prospective, randomized, controlled trial. Anesth Analg. 2010;110(1):199–207.
    1. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–1625.
    1. Kampe S, Geismann B, Weinreich G, Stamatis G, Ebmeyer U, Gerbershagen HJ. The influence of type of anesthesia, perioperative pain, and preoperative health status on chronic pain six months after thoracotomy: a prospective cohort study. Pain Med. 2017;18(11):2208–2213.
    1. Allama AM. Intercostal muscle flap for decreasing pain after thoracotomy: a prospective randomized trial. Ann Thorac Surg. 2010;89(1):195–199.
    1. Shaw A, Keefe FJ. Genetic and environmental determinants of postthoracotomy pain syndrome. Curr Opin Anaesthesiol. 2008;21(1):8–11.
    1. Underwood MJ, Firmin RK, Jehu D. Aspects of psychological and social morbidity in patients awaiting coronary artery bypass grafting. Heart. 1993;69(5):382–384.
    1. Fitzsimons D, Parahoo K, Richardson SG, Stringer M. Patient anxiety while on a waiting list for coronary artery bypass surgery: a qualitative and quantitative analysis. Heart Lung. 2003;32(1):23–31.
    1. Nelson F, Zimmerman L, Barnason S, Nieveen J, Schmaderer M. The relationship and influence of anxiety on postoperative pain in the coronary artery bypass graft patient. J Pain Symptom Manage. 1998;15(2):102–109.
    1. Greszta E, Siemińska MJ. Relationship of preoperative anxiety-state and anxiety-trait in patients qualified for coronary artery bypass graft surgery to the perception of postoperative pain and other pain complaints. Ann Acad Med Stetin. 2008;54(1):157–163. Polish.
    1. Thibodeau MA, Welch PG, Katz J, Asmundson GJ. Pain-related anxiety influences pain perception differently in men and women: a quantitative sensory test across thermal pain modalities. Pain. 2013;154(3):419–426.
    1. Dessotte CA, Rodrigues HF, Furuya RK, Rossi LA, Dantas RA. Stressors perceived by patients in the immediate postoperative of cardiac surgery. Rev Bras Enferm. 2016;69(4):741–750.
    1. Lahtinen P, Kokki H, Hendolin H. Pain after cardiac surgery: prospective cohort study of 1-year incidence and intensity. Anesthesiology. 2006;105(4):794–800.
    1. Reimer-Kent J. From theory to practice: preventing pain after cardiac surgery. Am J Crit Care. 2003;12(2):136–143.
    1. Carle C, Ashworth A, Roscoe A. A survey of post-sternotomy chronic pain following cardiac surgery. Anaesthesia. 2009;64(12):1387.
    1. van Leersum NJ, van Leersum RL, Verwey HF, Klautz RJ. Pain symptoms accompanying chronic poststernotomy pain: a pilot study. Pain Med. 2010;11(11):1628–1634.
    1. Meehan DA, Mcrae ME, Rourke DA, Eisenring C, Imperial FA. Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients. Am J Crit Care. 1995;4(6):435–442.
    1. Yorke J, Wallis M, Mclean B. Patients’ perceptions of pain management after cardiac surgery in an Australian critical care unit. Heart Lung. 2004;33(1):33–41.
    1. Puntillo K, Weiss SJ. Pain: its mediators and associated morbidity in critically ill cardiovascular surgical patients. Nurs Res. 1994;43(1):31–36.
    1. Kianfar A, Shadvar K, Mahoori A, Azarfarin R. Pain after cardiac surgery. Critical Care. 2007;11(Suppl 2):P429.
    1. Bruce J, Drury N, Poobalan SA, Jeffrey RR, Smith SW, Chambers AW. The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain. 2003;104(1):265–273.
    1. Hitt HC, McMillen RC, Thornton-Neaves T, Koch K, Cosby AG. Comorbidity of obesity and pain in a general population: results from the Southern Pain Prevalence Study. J Pain. 2007;8(5):430–436.
    1. Cadish LA, Hacker MR, Modest AM, Rogers KJ, Dessie S, Elkadry EA. Association between body mass index and pain following transobturator sling. J Obstet Gynaecol. 2017;37(6):766–769.
    1. Leacche M, Carrier M, Bouchard D, et al. Improving neurologic outcome in off-pump surgery: the “no touch” technique. Heart Surg Forum. 2003;6(3):169–175.
    1. Kazmierski J, Kowman M, Banach M, et al. Incidence and predictors of delirium after cardiac surgery: results from the IPDACS study. J Psychosom Res. 2010;69(2):179–185.
    1. Werner MU, Kongsgaard UE. I. Defining persistent post-surgical pain: is an update required? Br J Anaesth. 2014;113(1):1–4.
    1. Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology. 2003;99(4):982–987.
    1. Fine PG, Karwande SV. Sternal wire-induced persistent chest pain: a possible hypersensitivity reaction. Ann Thorac Surg. 1990;49(1):135–136.
    1. Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Chronic postsurgical pain in patients 5 years after cardiac surgery: a prospective cohort study. Eur J Pain. 2017;21(3):425–433.
    1. Guimarães-Pereira L, Farinha F, Azevedo L, Abelha F, Castro-Lopes J. Persistent postoperative pain after cardiac surgery: incidence, characterization, associated factors and its impact in quality of life. Eur J Pain. 2016;20(9):1433–1442.
    1. van Gulik L, Janssen LI, Ahlers SJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg. 2011;40(6):1309–1313.
    1. James SK. Chronic postsurgical pain: is there a possible genetic link? Br J Pain. 2017;11(4):178–185.
    1. Fletcher D, Stamer UM, Pogatzki-Zahn E, et al. Chronic postsurgical pain in Europe: an observational study. Eur J Anaesthesiol. 2015;32(10):725–734.
    1. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77–86.
    1. Setälä P, Kalliomäki ML, Järvelä K, Huhtala H, Sisto T, Puolakka P. Postoperative hyperalgesia does not predict persistent post-sternotomy pain: observational study based on clinical examination. Acta Anaesthesiol Scand. 2016;60(4):520–528.
    1. Guimares-Pereira L, Rejs P, Abelha F, Azevedo L, Castro-Lopes J. Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain. 2017;158(10):1869–1885.
    1. Eisenberg E, Pultorak Y, Pud D, Bar-El Y. Prevalence and characteristics of post coronary artery bypass graft surgery pain (PCP) Pain. 2001;92(1):11–17.
    1. Meyerson J, Thelin S, Gordh T, Karlsten R. The incidence of chronic post-sternotomy pain after cardiac surgery: a prospective study. Acta Anaesthesiol Scand. 2001;45(8):940–944.
    1. Routledge FS, Tsuyuki RT, Hervas-Malo M, Leblanc P, Mcfetridge-Durdle JA, King KM. The influence of coronary artery bypass graft harvest site on women’s pain, functional status, and health services utilization throughout the first post-operative year: a longitudinal study. Int J Nurs Stud. 2009;46(8):1054–1060.
    1. Bjørnnes AK, Parry M, Lie I, et al. Pain experiences of men and women after cardiac surgery. J Clin Nurs. 2016;25(19–20):3058–3068.
    1. Bayman EO, Brennan TJ. Incidence and severity of chronic pain at 3 and 6 months after thoracotomy: meta-analysis. J Pain. 2014;15(9):887–897.
    1. Niraj G, Kelkar A, Kaushik V, et al. Audit of postoperative pain management after open thoracotomy and the incidence of chronic postthoracotomy pain in more than 500 patients at a tertiary center. J Clin Anesth. 2017;36:174–177.
    1. Hetmann F, Kongsgaard UE, Sandvik L, Schou-Bredal I. Prevalence and predictors of persistent post-surgical pain 12 months after thoracotomy. Acta Anaesthesiol Scand. 2015;59(6):740–748.
    1. Wildgaard K, Ringsted TK, Hansen HJ, Petersen RH, Kehlet H. Persistent postsurgical pain after video-assisted thoracic surgery: an observational study. Acta Anaesthesiol Scand. 2016;60(5):650–658.
    1. Janssen KJ, Kalkman CJ, Grobbee DE, Bonsel GJ, Moons KG, Vergouwe Y. The risk of severe postoperative pain: modification and validation of a clinical prediction rule. Anesth Analg. 2008;107(4):1330–1339.
    1. Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth. 2011;107(4):619–626.
    1. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14(7):798–804.
    1. Breivik H, Borchgrevink PC, Allen SM, et al. Assessment of pain. Br J Anaesth. 2008;101(1):17–24.
    1. McCaffery M, Beebe A. Pain Clinical Manual for Nursing Practice. Maryland (MO): Mosby; 1989.
    1. Torda TA, Hann P, Mills G, de Leon G, Penman D. Comparison of extradural fentanyl, bupivacaine and two fentanyl-bupivacaine mixtures for pain relief after abdominal surgery. Br J Anaesth. 1995;74(1):35–40.
    1. Guillemin M. Understanding illness: using drawings as a research method. Qual Health Res. 2004;14(2):272–289.
    1. Egloff N, Cámara RJ, von Känel R, Klingler N, Marti E, Ferrari ML. Pain drawings in somatoform-functional pain. BMC Musculoskelet Disord. 2012;13:257.
    1. al-Ruzzeh S, Athanasiou T, Mangoush O, Modine T, George S, Amrani M. Predictors of poor mid-term health related quality of life after primary isolated coronary artery bypass grafting surgery. Heart. 2005;91(12):1557–1562.
    1. Nowicka-Sauer K, Jaroszewicz K, Szyndler K, Beta S, Siebers J. How to express pain and illness? Using drawing to assess pain and illness perceptions in patients awaiting coronary artery by-pass grafting surgery: preliminary report. Forum Med Rodz. 2015;9(3):288–290.
    1. Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30(2):191–197.
    1. Simchen E, Galai N, Braun D, et al. Sociodemographic and clinical factors associated with low quality of life one year after coronary bypass operations: the Israeli Coronary Artery Bypass study (ISCAB) J Thorac Cardiovasc Surg. 2001;121(5):909–919.
    1. Thompson M, Tiwari A, Fu R, Moe E, Buckley DI. A framework to facilitate the use of systematic reviews and meta-analyses in the design of primary research studies. 2012. [Accessed July 10, 2018]. Available from: .
    1. Maier C, Nestler N, Richter H, et al. The quality of pain management in German hospitals. Dtsch Arztebl Int. 2010;107(36):607–614.
    1. Liu WR, Zhang L, Woo SM, et al. A study of patient experience and perception regarding postoperative pain management in Chinese hospitals. Patient Prefer Adherence. 2013;7:1157–1162.
    1. Boitor M, Gélinas C, Richard-Lalonde M, Thombs BD. The effect of massage on acute postoperative pain in critically and acutely ill adults post-thoracic surgery: systematic review and meta-analysis of randomized controlled trials. Heart Lung. 2017;46(5):339–346.
    1. Myles PS, Daly DJ, Djaiani G, Lee A, Cheng DC. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology. 2003;99(4):982–987.
    1. Stasiowska MK, Ng SC, Gubbay AN, Cregg R. Postoperative pain management. Br J Hosp Med (Lond) 2015;76(10):570–575.
    1. Kruger M, McRae K. Pain management in cardiothoracic practice. Surg Clin North Am. 1999;79(2):387–400.
    1. White PF, Rawal S, Latham P, et al. Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology. 2003;99(4):918–923.
    1. Hynninen MS, Cheng DC, Hossain I, et al. Non-steroidal anti-inflammatory drugs in treatment of postoperative pain after cardiac surgery. Can J Anaesth. 2000;47(12):1182–1187.
    1. White PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs. 2008;9(1):76–82.
    1. Macintyre PE. Safety and efficacy of patient-controlled analgesia. Br J Anaesth. 2001;87(1):36–46.
    1. Walder B, Schafer M, Henzi I, Tramèr MR. Efficacy and safety of patient-controlled opioid analgesia for acute postoperative pain: a quantitative systematic review. Acta Anaesthesiol Scand. 2001;45(7):795–804.
    1. Pettersson PH, Lindskog EA, Owall A. Patient-controlled versus nurse-controlled pain treatment after coronary artery bypass surgery. Acta Anaesthesiol Scand. 2000;44(1):43–47.
    1. Bainbridge D, Martin JE, Cheng DC. Patient-controlled versus nurse-controlled analgesia after cardiac surgery: a meta-analysis. Can J Anaesth. 2006;53(5):492–499.
    1. Steinthorsdottir KJ, Wildgaard L, Hansen HJ, Petersen RH, Wildgaard K. Regional analgesia for video-assisted thoracic surgery: a systematic review. Eur J Cardiothorac Surg. 2014;45(6):959–966.
    1. Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol. 2008;74(10):549–563.
    1. Mehta Y, Vats M, Sharma M, Arora R, Trehan N. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease. Ann Card Anaesth. 2010;13(3):224–230.
    1. Caputo M, Alwair H, Rogers CA, et al. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: a prospective, randomized, controlled trial. Anesthesiology. 2011;114(2):380–390.
    1. Piraccini E, Pretto EA, Corso RM, Gambale G. Analgesia for thoracic surgery: the role of paravertebral block. HSR Proc Intensive Care Cardiovasc Anesth. 2011;3(3):157–160.
    1. d’Ercole F, Arora H, Kumar PA. Paravertebral block for thoracic surgery. J Cardiothorac Vasc Anesth. 2018;32(2):915–927.
    1. Wahal C, Kumar A, Pyati S. Advances in regional anaesthesia: a review of current practice, newer techniques and outcomes. Indian J Anaesth. 2018;62(2):94–102.
    1. Ozturk NK, Baki ED, Kavakli AS, et al. Comparison of transcutaneous electrical nerve stimulation and parasternal block for postoperative pain management after cardiac surgery. Pain Res Manag. 2016;2016:4261949.
    1. Hattan J, King L, Griffiths P. The impact of foot massage and guided relaxation following cardiac surgery: a randomized controlled trial. J Adv Nurs. 2002;37(2):199–207.
    1. Asmussen S, Przkora R, Maybauer DM, et al. Meta-analysis of electroacupuncture in cardiac anesthesia and intensive care. J Intensive Care Med. 2017 Jan 1; Epub.
    1. Racca V, Bordoni B, Castiglioni P, Modica M, Ferratini M. Osteopathic manipulative treatment improves heart surgery outcomes: a randomized controlled trial. Ann Thorac Surg. 2017;104(1):145–152.
    1. Keith M, Mokbel R, San Emeterio M, Song J, Errett L. Evaluation of taste sensitivity in patients undergoing coronary artery bypass graft surgery. J Am Diet Assoc. 2010;110(7):1072–1077.
    1. Stoppe C, Goetzenich A, Whitman G, et al. Role of nutrition support in adult cardiac surgery: a consensus statement from an international multidisciplinary expert group on nutrition in cardiac surgery. Crit Care. 2017;21(1):131.
    1. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduces anxiety and pain during chair rest after open-heart surgery. Pain. 2004;112(1–2):197–203.
    1. Bradt J, Dileo C, Potvin N. Music for stress and anxiety reduction in coronary heart disease patients. Cochrane Database Syst Rev. 2013;28(12):CD006577.

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