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MINERVA ANESTESIOLOGICA

A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Oct 12

DOI: 10.23736/S0375-9393.17.12142-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Perioperative pain management in cardiac surgery: a systematic review

Elena BIGNAMI 1 , Alberto CASTELLA 1 , Vincenzo POTA 2, Francesco SAGLIETTI 1, Antonio SCOGNAMIGLIO 3, Cinzia TRUMELLO 4, Maria C. PACE 2, Massimo ALLEGRI 5, 6

1 Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy 2 Department of Woman, Child, General & Specialized Surgery, University of Campania L. Vanvitelli, Naples, Italy; 3 Section of Anesthesia and Intensive Care, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy; 4 Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; 5 Anaesthesia, Intensive Care and Pain Therapy Unit, Division of Surgical Sciences, Department of Medicine and Surgery, University of Parma, Parma, Italy; 6 SIMPAR Group, Study In Multidisciplinary Pain Research


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BACKGROUND: Every year, more than 1.5 million patients, who undergo cardiac surgery worldwide, are exposed to a series of factors that can trigger acute postoperative pain associated with hemodynamic instability, respiratory complications, and psychological disorders. Through an evaluation of literature data about postoperative pain in cardiac surgery we define unmet needs and potential objectives for future research on this often underestimated problem.
METHODS: Following PRISMA Guidelines, a systematic literature search was carried out by two independent researchers on Scopus, CINAHL, the Cochrane Library, and PubMed using the keywords: [(perioperative OR postoperative) analgesia AND "cardiac surgery"]. Papers concerning children, or published prior to 2000, were considered ineligible, as well as abstracts, animal studies, and studies written in languages other than English.
RESULTS: Fifty-four papers were selected and subsequently divided into two main categories: systemic analgesic drugs and regional anesthesia techniques.
CONCLUSIONS: Over the past 17 years, opioids are still the most extensively used therapy, whereas we found only few trials investigating other drugs (e.g. paracetamol). Regional anesthesia techniques, especially thoracic epidural analgesia and intrathecal morphine administration, can effectively treat pain, but have not yet showed any significant impact on major clinical outcomes, with several concern related to their potential complications. To date multimodal analgesia with implementation of regional analgesia seems to be the best choice.
In the future, better-designed studies should consider other drugs stratifying groups according to comorbidities and risk factors, as well as using standardized units of measurement.


KEY WORDS: Cardiac-surgery - Pain - Analgesia - Pain-therapy - Postoperative - Perioperative - Thoracic-epidural - Intrathecal - Opiates

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Publication History

Article first published online: October 10, 2017
Manuscript accepted: October 10, 2017
Manuscript revised: October 3, 2017
Manuscript received: April 18, 2017

Cite this article as

Bignami E, Castella A, Pota V, Saglietti F, Scognamiglio A, Trumello C, et al. Perioperative pain management in cardiac surgery: a systematic review. Minerva Anestesiol 2017 Oct 12. DOI: 10.23736/S0375-9393.17.12142-5

Corresponding author e-mail

bignami.elena@hsr.it