Assessment and pathophysiology of pain in cardiac surgery

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.

Regional anesthesia for sternotomy and bypass—Beyond the epidural

“…Pain results in a stress response which impacts on postoperative recovery in all age groups. The mechanism and pathophysiology of pain with cardiac surgery have not been studied in children as extensively as in adults . In adults, pain after cardiac surgery is thought to be most severe during the first day and then decreases in intensity over the next few days.…”

“…The mechanism and pathophysiology of pain with cardiac surgery have not been studied in children as extensively as in adults. 3,4 In adults, pain after cardiac surgery is thought to be most severe during the first day and then decreases in intensity over the next few days. It is thought to be more severe in those who have undergone cardiopulmonary bypass (CPB), possibly due to the induction of systemic inflammatory response.…”

Atrial septal defect closure via mini-thoracotomy in pediatric patients: Postoperative analgesic effect of intercostal nerve block

“…[1][2][3] Postoperative pain management is important for these patients in terms of effective pulmonary functions and improved compliance with coughing and deep breathing, thereby decreasing the risk of pulmonary atelectasis and ventilation-perfusion abnormalities. [1,2] Although opioids are still the most common analgesic agents used after congenital heart surgery due to their excellent pharmacological properties for sedation and analgesia, their prolonged use is associated with several side effects, including respiratory depression and prolonged mechanical ventilation (MV). Furthermore, nausea and vomiting are the frequent adverse effects related to opioids.…”

“…Furthermore, nausea and vomiting are the frequent adverse effects related to opioids. [1][2][3][4][5] Regional anesthesia including intercostal nerve block (ICNB) has major advantages of providing effective analgesia without the central respiratory depression and gastrointestinal side effects related to the high dose of opioids. [1][2][3][4] The ICNB is a simple technique which can be performed easily by clinicians and provides effective analgesia with improved pulmonary mechanics, reduced central nervous system (CNS) depression.…”

“…[1][2][3][4][5] Regional anesthesia including intercostal nerve block (ICNB) has major advantages of providing effective analgesia without the central respiratory depression and gastrointestinal side effects related to the high dose of opioids. [1][2][3][4] The ICNB is a simple technique which can be performed easily by clinicians and provides effective analgesia with improved pulmonary mechanics, reduced central nervous system (CNS) depression. [3,4] In the present study, we aimed to evaluate the effects of ICNB with a long-acting local anesthetic combined with general anesthesia on postoperative pain, extubation time, and length of stay in the cardiovascular intensive care unit (CICU) in patients undergoing atrial septal defect (ASD) closure with right thoracotomy.…”