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New approaches and old controversies to postoperative pain control following cardiac surgery

Published online by Cambridge University Press:  04 April 2006

L. Roediger ,
R. Larbuisson  and
M. Lamy
L. Roediger
Affiliation:
University Hospital of Liége, Department of Anaesthesia and Intensive Care Medicine, Belgium
R. Larbuisson
Affiliation:
University Hospital of Liége, Department of Anaesthesia and Intensive Care Medicine, Belgium
M. Lamy
Affiliation:
University Hospital of Liége, Department of Anaesthesia and Intensive Care Medicine, Belgium
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Extract

Summary

Objective: To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures. Background: New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac surgical patients. Methods: We searched Medline for the period of 1980 to the present using the key terms analgesics, opioid, non-steroidal anti-inflammatory drugs, cardiac surgery, regional analgesia, spinal, epidural, fast-track cardiac anaesthesia, fast-track cardiac surgery, myocardial ischaemia, myocardial infarction, postoperative care, accelerated care programmes, postoperative complications, and we examined and discussed the articles that were identified to be included in this review. Results: Pain management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast-track management of conventional cardiac surgery patients. Advances have been made in this area and encompass specific techniques, such as central neuraxial blockade or selective nerve blocks, and drugs (opioids, sedative-hypnotics and non-steroidal anti-inflammatory drugs). Ideally, these therapies provide not only patient comfort but also mitigate untoward cardiovascular responses, pulmonary responses, and other inflammatory and secondary sympathetic responses. The introduction of these newer approaches to perioperative care has reduced morbidity, but not mortality, in cardiac surgical patients. Conclusions: Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of cardiac surgery, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Reorganization of the perioperative team (anaesthesiologists, surgeons, nurses and physical therapists) will be essential to achieve successful fast-track cardiac surgical programmes. Developments and improvements of multimodal interventions within the context of ‘fast-track’ cardiac surgery programmes represents the major challenge for the medical professionals working to achieve a ‘pain and risk free’ perioperative course.

Keywords

SURGERY CARDIACPAIN ACUTE AND POSTOPERATIVEANAESTHESIA SPINALANAESTHESIA EXTRADURALANAESTHESIA CONDUCTIONANAESTHETICS LOCALANALGESICS OPIOIDANALGESICS NONSTERIOIDAL
Type
EACTA Review
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 539 - 550
Copyright
© 2006 European Society of Anaesthesiology

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