Multicenter evidence based outcomes study comparing postoperative regional analgesic techniques following cardiac surgery

摘要

Background and aims: Cardiac surgery pain is due to a multiplicity of causes including, trauma of the surgical incision and manipulation of chest wall, tissue retraction and chest tubes. Inadequate control of pain following Coronary Artery Bypass Graft procedures may contribute to postoperative complications and delay in overall recovery. Opioid reduction strategies to limit adverse effects of these analgesic agents are becoming mandatory. This comparative effectiveness program evaluated the opioid reducing capabilities of a multimodal approach to postoperative pain management.Methods: 1248 subjects enrolled at 18 centers with a minimum of 15 patients per arm was requested. Patients in the ONQ arm received postoperative pain management with a continuous submuscular infusion of local anaesthetic and had available supplemental opioids for breakthrough pain delivered via PCA, IV, IM or oral modalities according to the standard of care at each institution. Patients in the control arm were treated with the standard of care at each institution for post-operative pain including opioids delivered via PCA, IV, IM or oral modalities. Opioid consumption, length of hospital and CCU stay, extubation time and pain reports were measured.Results: Significant decreases in pain, opioids, time to foley removal and return of bowel function and lengths of stay were found in the ONQ group vs control. Total opioids, pain, length of hospital stay and time to extubation all reduced (p< 0.001).Conclusion: A narcotic reducing strategy involving continuous sub muscular infusion of local anaesthetic as an intercostal/sternal block significantly affected recovery variables in post cardiac surgery patients.