Postoperative pain management in cardiac surgery patients

Introduction Pain after cardiac surgery can be caused by the incisions, cutting, heating, intraoperative tissue retraction and dissection, multiple intravascular cannulation, and chest tubes. Achieving optimal pain relief after cardiac surgery can be challenging. Most surgeons, anesthesiologist and nurses believe that cardiac surgery is not very painful, and related to that, pain levels after cardiac surgery are often severe and undertreated. The aim of this study is to evaluate perioperative pain management practices in patients undergoing cardiac surgery in the University hospital. Methods That is a prospective observational study including adult patients undergoing cardiac surgery. Patients were recruited on the first post-operative day (POD1). Assessment of patient reported outcomes (assessed in a questionnaire consisting of 13 questions, addressing severity of pain; its interference with activities; effect on affect; adverse effects; degree of satisfaction, whether the patient wished for more treatment for pain) and clinical variables were performed on the POD1. Results There were 130 patients (105 men), average age of 64.3±8.2 years. 44.8% of patients had worst pain higher than 6. 58.8% of patients were more than 20% of time in severe pain. High level of drowsiness was registered in 43.9% patients. Only 4% of patients have been out of bed on the POD1. 44.8% of patients wished more treatment. 73% of patients received morphine and 31.5% of patients received acetaminophen during the first 24 h after surgery for pain relief. Discussion It was suggested that incorrect assessment of pain, the use of protocols and inappropriate drug use, patients’ inability or unwillingness to communicate, and the hypothesis that patients should wake early from anesthesia and their blood pressure be stable, pain control is very often postponed to the next step. Several issues may be important for effective pain management, including providing the information about pain management options, systematic evaluation and the use of a multimodal approach.