Pain after cardiac surgery: Time to include multimodal pain management concepts in ERAS protocols

2022 ◽  
Vol 76 ◽  
pp. 110583
Alexander Fuchs ◽  
Paul Philipp Heinisch ◽  
Markus M. Luedi ◽  
Catherine S. Reid
2021 ◽  
pp. 000313482110246
Arad Abadi ◽  
Robbin Cohen

Background Recent guidelines for perioperative care in cardiac surgery recommend multimodal pain management to decrease opioid use. We evaluated the effect of multimodal pain management including parasternal intercostal nerve block on pain control and opioid use in patients who underwent coronary artery bypass grafting (CABG) requiring sternotomy and cardiopulmonary bypass. Study Design Medical records of consecutive patients who underwent CABG from 2018 to 2019 at Huntington Hospital were retrospectively queried. Patients were divided in 2 groups based on whether an Enhanced Recovery After Surgery (ERAS) pain management protocol including parasternal intercostal nerve blocks was employed. Outcomes, including length of stay, pain scores, and opioid use, were compared. Results There was no difference in length of stay (days) 5.43 vs. 5.38 ( P = .45 and average pain score 2.23 vs. 3.27 ( P = .137) for patients in the ERAS and non-ERAS groups. Maximum pain score, 7.74 to 6.15 ( P = .015), and opioid use (total morphine mg equivalent), 149.64 to 32.01 ( P < .01), were reduced in the ERAS group. Conclusion The ERAS multimodal pain management protocol utilizing intraoperative parasternal blocks appears to reduce pain and decrease opioid use after CABG.

Hand ◽  
2020 ◽  
pp. 155894472097514
Julian Zangrilli ◽  
Nura Gouda ◽  
Armen Voskerijian ◽  
Mark L. Wang ◽  
Pedro K. Beredjiklian ◽  

Background Adequate pain control is critical after outpatient surgery where patients are not as closely monitored. A multimodal pain management regimen was compared to a conventional pain management method in patients undergoing operative fixation for distal radius fractures. We hypothesized that there would be a decrease in the amount of narcotics used by the multimodal group compared to the conventional pain management group, and that there would be no difference in bone healing postoperatively. Methods Forty-two patients were randomized into 2 groups based on pain protocols. Group 1, the control, received a regional block, acetaminophen, and oxycodone. Group 2 received a multimodal pain regimen consisting of daily doses of pregabalin, celecoxib, and acetaminophen up until postoperative day (POD) #3. They also received a regional block with oxycodone for breakthrough pain. Results From POD#3 to week 1, there was a significant increase in oxycodone use in the study group correlating with the point in time when the multimodal regimen was discontinued. The shortened Disabilities of the Arm, Shoulder, and Hand Questionnaire (QuickDASH) scores taken at 2 weeks postoperation showed a significantly lower average score in the study group compared to the control. There was no difference in bone healing. Conclusions The 2 regimens yielded similar pain control after surgery. The rebound increase in narcotic use after the multimodal regimen was discontinued, and significant difference in QuickDASH scores seen at 2 weeks postoperatively supported that multimodal regimens may not necessarily lead to decreased narcotic use in outpatient upper extremity surgery, but in the short term are shown to improve functional status.

2018 ◽  
Vol 46 (1) ◽  
pp. 775-775 ◽  
Alexandra Greco ◽  
Janie Faris ◽  
Vic DeLapp ◽  
Jason Hoffman

2018 ◽  
Vol 21 (3) ◽  
pp. 333 ◽  
PS Nagaraja ◽  
KarthikNarendra Kumar ◽  
RavikumarNagashetty Kalyane ◽  
NaveenG Singh ◽  
Madhu Krishna ◽  

Pain ◽  
2012 ◽  
Vol 153 (1) ◽  
pp. 197-202 ◽  
Christoph Pieh ◽  
Jürgen Altmeppen ◽  
Susanne Neumeier ◽  
Thomas Loew ◽  
Michael Angerer ◽  

2012 ◽  
pp. 458-464
Siân I. Jaggar ◽  
Amod Manocha

2018 ◽  
Vol 218 (1) ◽  
pp. S117
Emily E. Hadley ◽  
Luis Monsivais ◽  
Lucia Pacheco ◽  
Yara Ramirez ◽  
Viviana Ellis ◽  

Spine ◽  
2020 ◽  
Vol 45 (9) ◽  
pp. 580-589 ◽  
Crispiana Cozowicz ◽  
Janis Bekeris ◽  
Jashvant Poeran ◽  
Nicole Zubizarreta ◽  
Eric Schwenk ◽  

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