Abstract
Pain following cardiac surgery is a multifaceted phenomenon resulting from a number of mechanisms. High-levels of post-operative pain are associated with cardiovascular and respiratory complications and adequate pain management is crucial for enabling fast recovery. However, adequate pain control is complex, a challenge that stems from a combination of poor reporting of pain, significant variation amongst patients and the side-effects of strong, particularly opioid, analgesics. An initial audit at our hospital demonstrated high-levels of post-operative pain following cardiac surgery and a protocol was therefore devised by the anaesthetic department for cardiac surgical pain management. The protocol stratified patients into high- or low-risk of pain based on the presence of risk factors for pain and utilised a combination of pre-operative one-off dose of gabapentin, intra-operative opioid infusion and post-operative multimodal analgesia with paracetamol, weak and strong opioids. Additionally, patients at high-risk of pain also received patient controlled analgesia. Use of this protocol was associated with improved pain scores on the first three post-operative days. We have devised this study to test for reproducibility of the benefit experienced at our hospital at a larger multicentre level. After acquiring pre-existing post-operative pain management strategies through an initial survey, local study leads will undertake a baseline audit. Local study leads will then lead a 4-week period of protocol implementation. Trusts with official pain management protocols will be given the option to re-circulate their pre-existing protocols. Subsequently, pain scores during post-operative days 1–3 will be re-audited.
Highlights
Pain following cardiac surgery is common, and, despite being largely avoidable, is moderate to severe in up to 75% of patients [1]
Nociceptive pain can be further exaggerated by the inflammation inherent with cardiopulmonary bypass and anaesthetic drugs [2]
Given the possible substantial benefit to pain levels in this institution, and no current national guidance for pain following cardiac surgery, a multicentre audit was designed: 1) to assess whether this protocol, across a wider demographic of patients and increased number of patients, can be beneficial in all cardiac centres; 2) whether it is useful to distinguish between high- and low-risk patients, and, 3) whether a pre-operative dose of gabapentin has any effect on post operative pain
Summary
Pain following cardiac surgery is common, and, despite being largely avoidable, is moderate to severe in up to 75% of patients [1]. Pain can prolong hospital stays and cause significant morbidity including psychology distress and in some cases, chronic pain
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