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Revista de la Sociedad Española del Dolor

versão impressa ISSN 1134-8046

Resumo

ESTEVE-PEREZ, N et al. Effectiveness of patient-controlled analgesia in acute and chronic pain after cardiac surgery: a prospective study. Rev. Soc. Esp. Dolor [online]. 2020, vol.27, n.1, pp.24-36.  Epub 27-Abr-2020. ISSN 1134-8046.  https://dx.doi.org/10.20986/resed.2020.3747/2019.

Introduction:

The intensity of postoperative moderate/intense pain after cardiac surgery (CC), varies according to the different studies, from 45 % to 85 %. There is no evidence about which is the optimal analgesic regimen in the postoperative period.

The main objective of this study is to evaluate the effectiveness of the application of a multimodal analgesic protocol, based on patient-controlled analgesia (PCA) with morphine, in patients undergoing cardiac surgery with extracorporeal circulation (ECC).

Patients and methods:

Prospective observational study of all patients undergoing CS with ECC, during the first 3 days postoperatively. There were included 102 patients in two periods, first, in November 2016 with conventional analgesia and second, in January - February 2017 with PCA.

Results:

The pain at rest was controlled (median numerical scale <3). An average of 27 % of moderate and intense pain was recorded. There was no difference in pain intensity between patients with CA and those with PCA. The PCA group required less rescue analgesia in the first postoperative days (63 % vs. 44 % p = 0.0487). The incidence of Post-surgical Chronic Pain was 39 % at three months, and 3 % at one year. There was a correlation between preoperative pain and anxiety with the intensity of the dynamic pain (r = 0.287, p = 0.03).

Conclusions:

PCA with on-demand opioids and multimodal analgesia is an effective alternative after cardiac surgery. Good control of postoperative pain is obtained without increasing adverse effects, and requiring less rescue analgesia administered by the nursing staff.

Palavras-chave : Postoperative Analgesia; cardiac surgery; multimodal analgesia; patient controlled analgesia (PCA).

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