Drug Design, Development and Therapy (Jun 2023)

Evaluation of the Effect of New Multimodal Analgesia Regimen for Cardiac Surgery: A Prospective, Randomized Controlled, Single-Center Clinical Study

  • Jin L,
  • Liang Y,
  • Yu Y,
  • Miao P,
  • Huang Y,
  • Xu L,
  • Wang H,
  • Wang C,
  • Huang J,
  • Guo K

Journal volume & issue
Vol. Volume 17
pp. 1665 – 1677

Abstract

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Lin Jin,1 Yafen Liang,2 Ying Yu,1 Peng Miao,1 Yihao Huang,1 Liying Xu,1 Huilin Wang,1 Chunsheng Wang,3 Jiapeng Huang,4 Kefang Guo1 1Department of Anesthesia, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Department of Anesthesiology, University of Texas Health Center at Houston, Houston, TX, USA; 3Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 4Department of Anesthesiology & Perioperative Medicine University of Louisville, Louisville, KY, USACorrespondence: Kefang Guo, Department of Anesthesia, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, People’s Republic of China, Email [email protected] Jiapeng Huang, Department of Anesthesiology & Perioperative Medicine University of Louisville, Louisville, KY, 40202, USA, Email [email protected]: To investigate the feasibility of multimodal regimen by paracetamol, gabapentin, ketamine, lidocaine, dexmedetomidine and sufentanil among cardiac surgery patients, and compare the analgesia efficacy with conventional sufentanil-based regimen.Design: A single-center, prospective, randomized, controlled clinical trial.Setting: One participating center, the cardiovascular center of the major integrated teaching hospital.Participants: A total of 115 patients were assessed for eligibility: 108 patients were randomized, 7 cases were excluded.Interventions: The control group (group T) received conventional anesthesia management. Interventions in the multimodal group (group M) were as follows in addition to the standard of care: gabapentin and acetaminophen 1 hour before surgery; ketamine for induction and to maintain anesthesia with lidocaine and dexmedetomide. Ketamine, lidocaine, and dexmedetomidine were added to routine sedatives postoperatively in group M.Measurements and Main Results: The incidence of moderate-to-severe pain on coughing made no significant difference (68.5% vs 64.8%, P=0.683). Group M had significantly less sufentanil use (135.72μg vs 94.85μg, P=0.000) and lower rescue analgesia rate (31.5% vs 57.4%, P=0.007). There was no significant difference in the incidence of chronic pain, PONV, dizziness, inflammation index, mechanical ventilation time, length of stay, and complications between the two groups.Conclusion: Our multimodal regimen in cardiac surgery is feasible, but was not superior to traditional sufentanil-based regimen in the aspects of analgesia effects; however, it did reduce perioperative opioid consumption along with rescue analgesia rate. Moreover, it showed the same length of stay and the incidences of postoperative complications.Keywords: cardiac surgery, multimodal analgesia, prognosis

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