Reducing Opioid Use in Patients Undergoing Cardiac Surgery – Preoperative, Intraoperative, and Critical Care Strategies

Ochroch, Jason; Usman, Asad; Kiefer, Jesse; Pulton, Danielle; Shah, Ro; Grosh, Taras; Patel, Saumil; Vernick, William J.; Gutsche, Jacob T.; Raiten, Jesse

doi:10.1053/j.jvca.2020.09.103

Cited by 20 publications

(16 citation statements)

References 101 publications

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“…It is frequently used as an anesthetic adjunct after major surgery, including cardiac surgery. 106 In patients undergoing VATS, evidence has shown that intraoperative dexmedetomidine can reduce postoperative pain, patient satisfaction, and improve pulmonary mechanics. 107,108 Data regarding the benefit of postoperative administration are unclear because of mixed results and heterogenous administration regimens between studies.…”

Section: Locoregional Analgesiamentioning

confidence: 99%

“…Ketamine is a sympathomimetic that at high doses may cause tachycardia, hypertension, negative inotropy, and increased myocardial oxygen demand. 106 While it has been shown to have mild success reducing opioid consumption and postoperative delirium after open cardiac surgery, 115 there are limited data of ketamine in MICTS, largely because of its prohibitive side-effect profile.…”

Section: Locoregional Analgesiamentioning

confidence: 99%

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Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Sherazee

Chen

et al. 2022

Innovations�(Phila)

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Section: Locoregional Analgesiamentioning

confidence: 99%

Section: Locoregional Analgesiamentioning

confidence: 99%

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Sherazee

Chen

et al. 2022

Innovations�(Phila)

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“…Traditionally, opioids were considered the mainstay for pain management after CS based on a predictable hemodynamic profile. Acknowledged risks associated with their use (e.g., hyperalgesia, opioid dependence, respiratory depression, nausea and vomiting, immunosuppression, ileus, delirium, prolonged postoperative recovery) fueled that which now represents a central tenet in the ERAS paradigm–multimodal analgesia (MA) [ 8 ]. MA built on drug combinations is not faultless [ 9 ]; N-methyl-D-aspartate (NMDA) antagonists may bring about sympathetic hyperactivity, central alpha-2 agonists can cause bradycardia and hypotension, and nonsteroidal anti-inflammatory agents are associated with renal dysfunction and abnormal clotting.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery

et al. 2021

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“…Opioids have been the mainstay of pain management, but their side effects complicate patient recovery and increase costs. Consequently, opioid-sparing has become a fundamental tenet of the enhanced recovery after surgery (ERAS) paradigm, aiming to reduce the length of stay (LOS) and optimize resource utilization [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery: A Randomized Controlled Clinical Trial

et al. 2022

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Background and Objectives: The erector spinae plane block (ESPB) is a multimodal opioid-sparing component, providing chest-wall analgesia of variable extent, duration, and intensity. The objective was to examine the ESPB effect on perioperative opioid usage and postoperative rehabilitation when used within a Nociception Level (NOL) index-directed anesthetic protocol. Materials and Methods: This prospective, randomized, controlled, open-label study was performed in adult patients undergoing on-pump cardiac surgery in a single tertiary hospital. Eighty-three adult patients who met eligibility criteria were randomly allocated to group 1 (Control, n = 43) and group 2 (ESPB, n = 40) and received general anesthesia with NOL index-directed fentanyl dosing. Preoperatively, group 2 also received bilateral single-shot ultrasound-guided ESPB (1.5 mg/kg/side 0.5% ropivacaine mixed with dexamethasone 8 mg/20 mL). Postoperatively, both groups received intravenous paracetamol (1 g every 6 h). Morphine (0.03 mg/kg) was administered for numeric rating scale (NRS) scores ≥4. Results: The median (IQR, 25th–75th percentiles) intraoperative fentanyl and 48 h morphine dose in group 2-to-group 1 were 1.2 (1.1–1.5) vs. 4.5 (3.8–5.5) µg·kg−1·h−1 (p < 0.001) and 22.1 (0–40.4) vs. 60.6 (40–95.7) µg/kg (p < 0.001). The median (IQR) time to extubation in group 2-to-group 1 was 90 (60–105) vs. 360 (285–510) min (p < 0.001). Two hours after ICU admission, 87.5% of ESPB patients were extubated compared to 0% of controls (p < 0.001), and 87.5% were weaned off norepinephrine compared to 46.5% of controls (p < 0.001). The median NRS scores at 0, 6, 12, 24, and 48 h after extubation were significantly decreased in group 2. There was no difference in opioid-related adverse events and length of stay. Conclusions: NOL index-directed ESPB reduced intraoperative fentanyl by 73.3% and 48 h morphine by 63.5%. It also hastened the extubation and liberation from vasopressor support and improved postoperative analgesia.

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Reducing Opioid Use in Patients Undergoing Cardiac Surgery – Preoperative, Intraoperative, and Critical Care Strategies

Cited by 20 publications

References 101 publications

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Pain Management Strategies for Minimally Invasive Cardiothoracic Surgery

Ultrasound-Guided Regional Anesthesia–Current Strategies for Enhanced Recovery after Cardiac Surgery

Nociception Level Index-Directed Erector Spinae Plane Block in Open Heart Surgery: A Randomized Controlled Clinical Trial

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