Pain after Coronary Artery Bypass Grafting Surgery Pasi Lahtinen Pain after Coronary Artery Bypass Grafting Surgery

Pain after cardiac surgery has long been neglected and considered insignificant. Postoperative pain has only recently been recognized as an important problem and a potential origin of persistent pain and long-term suffering. Changing surgical and anesthesia practices have placed new demands on postoperative care after cardiac surgery. There are few prospective studies of acute and persisting pain after cardiac surgery. Although acute postoperative pain has been mild in retrospective studies, persistent longterm pain has high prevalence: 21% to 56%. However, in most studies the time interval between surgery and completion of the postoperative questionnaire has been long, which might have affected the data gathered. The present study was conducted to investigate patients’ expectations and experiences of acute and persisting postoperative pain after cardiac surgery. The questionnaires were performed preoperatively; on the fifth postoperative day; and at 1, 3, 6, and 12 months after surgery. The second aim was to study the efficacy and feasibility of the opioid adjuvants propacetamol and ketamine in acute pain therapy after cardiac surgery. We also explored whether remifentanil infusion during coronary artery bypass grafting (CABG) surgery will increase pain and opioid requirements postoperatively. Patients experienced more postoperative pain at rest than they had expected preoperatively. The worst reported acute postoperative pain was severe in 49% of patients at rest, in 79% during coughing, and in 62% on movement. One year after the operation, 14% of patients reported mild persisting post-sternotomy pain at rest, 1% experienced moderate pain, and 3% experienced severe pain. Patients with moderate to severe acute postoperative pain reported chronic post-sternotomy pain more frequently than patients with only mild postoperative pain. Propacetamol had no opioid-sparing effect, nor did it enhance analgesia after CABG surgery. However, in post hoc analysis, oxycodone requirement was reduced approximately 19% in the propacetamol group compared with the placebo group during the first 24 h after surgery. S(+)-ketamine had an opioid-sparing effect (1 %) after CABG surgery. However, pain scores or adverse events were not reduced compared with the placebo group. Three-h remifentanil infusion (0.3μg/kg/min) did not increase postoperative pain or postoperative opioid consumption. National Library of Medical Classification: WG 169, WO 184 Medical Subject Headings: Coronary Artery Bypass; Analgesics, Opioid; Cardiac Surgical Procedures/adverse effects; Drug Therapy, Combination; Ketamine; Oxycodone; Pain, Postoperative/drug therapy; Pain, Postoperative/prevention & control 7