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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 December;65(12):859-65

language: English

Post­op­er­a­tive anal­gesia for ­early extu­ba­tion after car­diac sur­gery. A pros­pec­tive, ran­dom­ized ­trial

Ranuci M., Cazzaniga A., Soro G., Isgrò G., Rossi R., Pavesi M.

Università ­degli ­Studi - ­Milano , Dipar­ti­mento di Car­di­oa­nes­tesia, Centro Car­di­o­vas­co­lare E. ­Malan, Ospe­dale Clin­i­ciz­zato S. ­Donato, S. ­Donato Mil­a­nese (­Milano)


Back­ground. ­Early extu­ba­tion ­after car­diac sur­gery is a pro­ce­dure ­recently ­gaining ­interest due to its ­ability to ­shorten inten­sive ­care ­unit and hos­pital ­stay and to ­limit the oper­a­tion-­related ­costs. Its use, how­ever, ­raised new prob­lems in ­terms of ­pain con­trol in the ­early post­op­er­a­tive ­course, due to the ­need for lim­iting ­opioid anal­gesia.
­This ­study ­deals ­with non-­opioid ­pain con­trol ­after car­diac sur­gery and ­early extu­ba­tion.
­Methods. Pros­pec­tive, ran­dom­ized ­trial ­aimed to inves­ti­gate the effec­tive­ness of ­three intra­ve­nous anal­gesic ­drugs (ketor­olac, 60 mg i.v.; prop­a­cet­amol, 2 g i.v.; tram­adol, 200 mg i.v.) for the man­age­ment of post­op­er­a­tive ­pain in ­early extu­bated car­diac sur­gical ­patients. ­Each treat­ment ­group com­prised 20 ­patients.
­Results. The ­pain assess­ment (5-­item ­verbal ­scale) dem­on­strated a sig­nif­i­cant (p<0.05) ­lower ­value in ­patients ­treated ­with ketor­olac vs prop­a­cet­amol, ­while ­patients ­treated ­with tram­adol did not sig­nif­i­cantly ­differ ­from the ­other two ­groups. ­There was a sig­nif­i­cantly (p<0.05) ­higher ­rate of ­patients ­with ­severe ­pain in prop­a­cet­amol ­group. ­Patients ­treated ­with tram­adol had a sig­nif­i­cantly (p<0.01) ­higher ­PaCO2 (48±6 ­mmHg) ­versus ­patients ­treated ­with ketor­olac (43.4±3.7 ­mmHg) or prop­a­cet­amol (42.9±3.4 ­mmHg).
Con­clu­sions. Tram­adol and ketor­olac ­seem to be the ­best ­options for ­treating post­op­er­a­tive ­pain in the spe­cific set­ting of ­early extu­ba­tion ­after car­diac sur­gery; ­high ­doses of tram­adol may ­result in a sig­nif­i­cant ­even if clin­i­cally not rel­e­vant res­pir­a­tory depres­sion.

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