Comparative Study of Multimodal Analgesia and Morphine Analgesia Concerning the Adverse Effects Following Open-Heart Surgeries

Abstract

Background: Historically, pain management has been based on opioid analgesics after cardiac surgeries. Opiates, however, have adverse dose-related side effects that have an impact on the recovery of patients. So, evidence-based opioids that spare multimodal analgesia are progressively being used. Objective: To determine if the multimodal opioid-sparing treatment of dexamethasone, gabapentin, ibuprofen, ketorolac, and paracetamol had fewer side effects and was safe following open-heart surgeries compared to morphine. Patients and Methods: This prospective, double-blinded randomized, and controlled clinical study was performed on 60 patients scheduled for elective open-heart surgeries with sternotomy at Sohag University Hospital they were be randomly allocated into two equal groups, 30 patients each in the Cardiothoracic Department, Sohag University. Results: Fewer side effects occurred in patients in the multimodal group than in the morphine group. There was nausea and constipation in patients on the morphine versus multimodal group (21versus 0) with a ratio of 70% (p- value 0.001). Vomiting occurred in patients in the morphine group (12 versus 4) relative to the multimodal group with a ratio of 40% (p –value 0.020). Postoperative creatinine value showed no statistically significant difference in values between the two groups in all days, with the exception of day zero, showing lower values in the multimodal group creatinine level (0.82 ± 0.25 versus 1.02 ± 0.28 in morphine group (p-value 0.006). Conclusions: The multimodal regimen offered lower side effects than morphine group in patients undergoing cardiac surgery. There dramatically decreased complaint of nausea, vomiting, constipation, and respiratory depression. In terms of renal complication, no safety issues were found with the multimodal regimen.