J Anesth Perioper Med. 2018;5(6):333-345. https://doi.org/10.24015/ebcmed.japm.2018.0070

Clinical Implementation of A Multimodal Analgesia Regimen for Cardiac Surgical Patients

Roya Saffary1, Cody Parsons2, Einar Ottestad1, Heather Pulley3, Corinne Pogemiller3, Jack H. Boyd4, and Albert T. Cheung1

From the 1Department of Anesthesiology, Stanford University; 2Department of Pharmacy, Stanford Health Care; 3Stanford Health Care; 4Department of Cardiothoracic Surgery, Stanford University; all in Stanford, CA, USA.

Correspondence to Dr. Roya Saffary at saffary@stanford.edu.

EBCMED ID: ebcmed.japm.2018.0070 DOI: 10.24015/ebcmed.japm.2018.0070


Aim of review
Enhanced recovery after surgery (ERAS) protocols that utilize a multimodal, narcotic-sparing approach to pain management have proven to be effective for colorectal and other surgical subspecialties. However, perioperative pain management for cardiac surgical patients remain suboptimal and based primarily on the use of narcotic analgesics that expose patients to potential short- and long-term complications of opioid therapy. The objective of this investigation was to review the existing clinical evidence on the safety and efficacy of non-narcotic analgesics for the treatment of postoperative pain to create and implement a perioperative multimodal analgesic regimen that can be integrated into the current pain management practices for patients undergoing cardiothoracic operations.

A multidisciplinary task force consisting of anesthesiologists, surgeons, nurses, physician assistants, and pharmacists from the cardiovascular health service line was appointed to develop a standard order set in the electronic health record for the treatment of postoperative pain in patients undergoing cardiac operations. The PubMed and Cochrane databases were searched for studies on perioperative pain management after cardiac surgery. The available data were reviewed for quality and relevance to the management of cardiac surgical patients. Once consensus was achieved, an order set was created and universally applied for all cardiac surgical patients admitted to the surgical cardiovascular intensive care unit after the operation.

Recent findings
Evidence exists to support the safety and efficacy of a multimodal pain management protocol for cardiac surgical patients in an effort to improve patient satisfaction and comfort while limiting the adverse effects of opioid analgesics.

A multidisciplinary task force achieved consensus in creating an evidencebased, opioid-sparing, multi-modal medication order set for the management of postoperative pain in cardiac surgical patients. The standardized analgesic regimen was compliant with guidelines of The Joint Commission, widely accepted and quickly adopted in clinical use. Continuing investigations will be directed at quantifying whether the multimodal analgesic regimen will improve patient satisfaction, decrease postoperative pain scores, and reduce the incidence of opioid-related adverse events.

Article Type
Review Article

Declaration of Interests
The authors declare no conflicts of interest.

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