Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial

Abstract

BackgroundTo evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery.MethodsOpen-label, prospective randomized controlled trial. 180 patients undergoing cardiac procedures through median sternotomy, were included in the period march 2007- August 2009. 151 patients were available for analysis. Pain was assessed with the 11-numeric rating scale (11-NRS).ResultsPatients in the multimodal group demonstrated significantly lower average pain scores from the day of surgery throughout the third postoperative day. Extensive nausea and vomiting, was found in no patient in the multimodal group but in 13 patients in the morphine group, p < 0.001. Postoperative rise in individual creatinine levels demonstrated a non-significant rise in the multimodal group, 33.0±53.4 vs. 19.9±48.5, p = 0.133. Patients in the multimodal group suffered less major in-hospital events in crude numbers: myocardial infarction (MI) (1 vs. 2, p = 0.54), stroke (0 vs. 3, p = 0.075), dialysis (1 vs. 2, p = 0.54), and gastrointestinal (GI) bleeding (0 vs. 1, p = 0.31). 30-day mortality was 1 vs. 2, p = 0.54.ConclusionsIn patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed with the multimodal regimen.Trial registrationClinicaltrials.gov identifier: NCT01966172

Nurse‐led post‐thoracic surgery pain management programme: its outcomes in a Nigerian Hospital

“…Our findings regarding the effectiveness of this PMP in reducing pain intensity are consistent with those of previous studies where pain management interventions resulted in a lower pain intensity after thoracic surgery (Chen et al 2016;Kol et al 2012a,b;Rafiq et al 2014;Yu et al 2015). In line with previous studies, our results indicate that the implementation of a pain management programme yields less frequent pain treatment side effects (Chen et al 2016;Li et al 2016;Rafiq et al 2014).…”

“…The PMP in this study is an evidence-based pain management (EBPM) programme that significantly decreased the pain intensity and side effects of the treatment (nausea and drowsiness). This is similar to the findings from other studies where EBPMs were implemented for post-operative pain management in different populations such as patients undergoing abdominal surgery (Joshi et al 2013), gastrointestinal surgery (Haghighi et al 2016), cardiac surgery (Rafiq et al 2014) and (Ard o et al 2018;Dinic et al 2018;Hayashi et al 2017;Starkweather & Perry 2017;White & Dixon 2015;Zvara 2017).…”

“…; Rafiq et al. ). A key contributor to this positive outcome and a high level of patient satisfaction without increasing the incidence of adverse events might have been the demystification of the standardized care programme specifically developed for thoracic surgery patients (French et al.…”

Perioperative factors associated with persistent opioid use after extensive abdominal surgery in children and adolescents: A retrospective cohort study

“…At our institution, opioids form the basis of the perioperative analgesic regimen for children undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy, and a multimodal approach is typically introduced only when postoperative opioid requirements increase. However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies . Of particular interest in this patient population may be the early inclusion of anti‐hyperalgesic agents such as methadone, ketamine, and dexmedetomidine.…”

“…However, multimodal analgesia has been associated with improved pain scores and reduced opioid consumption in several studies. [16][17][18][19] Of particular interest in this patient population may be the early inclusion of anti-hyperalgesic agents such as methadone, ketamine, and dexmedetomidine. There is evidence to suggest that NMDA receptor antagonism by these agents may prevent opioid-induced hyperalgesia and reduce acute tolerance to the analgesic effects of opioids.…”