Abstract
The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase.To determine whether a continuous subcutaneous regional anesthetic infusion delivered directly to the sternotomy site would result in decreased levels of postoperative pain and opioid requirements in cardiac surgical patients undergoing median sternotomy.The continuous subcutaneous infusion (OnQ Painbuster system) was applied in 37 patients. 3 patients were exempted due to prolonged ICU stay. 29 patients underwent CABG, 5 had AVR, 1 MVR and modified Maze, 1 patient had a 3-valve repair due to endocarditis and another one had reconstruction of the left ventricle. Requirements of opioid analgesics were recorded for 96 hours after operation. Pain was assessed using the visual analog scale and the total postoperative hospital length of stay was also measured.The postoperative pain was significantly diminished (0 – 3 at VAS). The mean postoperative length of stay was 5,8 days, rather improved compared to the average stay of 6,7 days.Continuous subcutaneous infusion of ropivacaine directly at the median sternotomy significantly diminishes postoperative pain and the need for opioid analgesic use. Moreover, it seems to reduce overall postoperative length of stay for all cardiac surgical patients.
Highlights
One of the majors concerns of any surgical patient entering an ICU is pain
Pain is mostly due to median sternotomy and it seems to be higher on the first two days which is the usual length of stay at the cardiac ICU [1]
This undesired prolongation of length of hospital stay because of opioid side effects is well known to surgeons, anesthesiologists and nursing personnel caring for the cardiac surgical patient sustaining a median sternotomy [2,4]
Summary
One of the majors concerns of any surgical patient entering an ICU is pain. In cardiac surgical patients, pain is mostly due to median sternotomy (or sometimes thoracotomy) and it seems to be higher on the first two days which is the usual length of stay at the cardiac ICU [1].(page number not for citation purposes)Journal of Cardiothoracic Surgery 2008, 3:2 http://www.cardiothoracicsurgery.org/content/3/1/2Traditional teaching suggests that pain after median sternotomy is alleviated best with parenteral opioid-based analgesics. Opioid analgesics are well known for their major and sometimes dreadful side effects, especially on cardiac surgical patients who should be discharged from ICU on a fast tract protocol [1,2,3] Opioid adverse effects such as respiratory depression, nausea, vomiting, decreased gastro-intestinal (GI) motility or even ileus and urinary retention can prolong the length of stay of patients on the cardiac surgical ICU or at the ward. This undesired prolongation of length of hospital stay because of opioid side effects is well known to surgeons, anesthesiologists and nursing personnel caring for the cardiac surgical patient sustaining a median sternotomy [2,4]
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