Enhanced Recovery After Surgery (ERAS) cardiac turnkey order set for perioperative pain management in cardiac surgery: Proceedings from the American Association for Thoracic Surgery (AATS) ERAS Conclave 2023

被引:1
作者
Gregory, Alexander J. [1 ,2 ]
Arora, Rakesh C. [3 ]
Chatterjee, Subhasis [4 ]
Crisafi, Cheryl [5 ]
Morton-Bailey, Vicki [6 ]
Rea, Amanda [7 ]
Salenger, Rawn [8 ]
Engelman, Daniel T. [5 ]
Grant, Michael C. [9 ]
Cangut, Busra [10 ]
Crotwell, Shannon [11 ]
Lobdell, Kevin W. [13 ]
McConnell, Gina [12 ]
Reddy, Seenu [10 ,13 ]
机构
[1] Univ Calgary, Cumming Sch Med, Dept Anesthesiol, Calgary, AB, Canada
[2] Univ Calgary, Libin Cardiovasc Inst, Calgary, AB, Canada
[3] Case Western Reserve Univ, Univ Hosp, Harrington Heart & Vasc Inst, Div Cardiac Surg,Dept Surg, Cleveland, OH USA
[4] Baylor Coll Med, Dept Surg, Houston, TX USA
[5] Univ Massachusetts, Heart & Vasc Program, Baystate Hlth, Chan Med Sch Baystate, Springfield, MA USA
[6] Providence Anesthesiol Associates, Charlotte, NC USA
[7] Univ Maryland, St Joseph Med Ctr, Div Cardiac Surg, Towson, MD USA
[8] Univ Maryland, Sch Med, Dept Surg, Baltimore, MD USA
[9] Johns Hopkins Univ, Sch Med, Dept Anesthesiol & Crit Care Med, Baltimore, MD USA
[10] Icahn Sch Med Mt Sinai, New York, NY USA
[11] Sanger Heart & Vasc Inst, Charlotte, NC USA
[12] WakeMed Hlth, Raleigh, NC USA
[13] TriStar Centennial Med Ctr, Nashville, TN USA
来源
JTCVS OPEN | 2024年 / 22卷
关键词
pain; analgesia; multimodal analgesia; opioid; opioid-sparing; comfort; enhanced recovery; perioperative care; ARTERY-BYPASS SURGERY; DOUBLE-BLIND; POSTOPERATIVE PAIN; INTRAVENOUS ACETAMINOPHEN; INTRAOPERATIVE METHADONE; DEXMEDETOMIDINE; ANALGESIA; ANESTHESIA; GUIDELINES; PREGABALIN;
D O I
10.1016/j.xjon.2024.08.018
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Optimal perioperative pain management is an essential component of perioperative care for the cardiac surgical patient. This turnkey order set is part of a series created by the Enhanced Recovery After Surgery Cardiac Society, fi rst presented at the Annual Meeting of The American Association for Thoracic Surgery in 2023. Several guidelines and expert consensus documents have been published to provide guidance on pain management and opioid reduction in cardiac surgery. Our objective is to consolidate that guidance into an evidence-based order set that will assist in the implementation of a comprehensive multimodal approach to pain management. Methods: Subject matter experts were consulted to translate existing guidelines and peer-reviewed literature into a sample turnkey order set for pain management. Orders derived from consistent Class I, IIA, or equivalent recommendations across referenced guidelines and consensus manuscripts appear in the order set in bold type. Selected orders that were inconsistently Class I or IIA, Class IIB, or supported by published evidence, were also included in italicized type. Results: Opioid-based analgesia is associated with delayed recovery and opioidrelated adverse events. Several multimodal medications have been shown to reduce reliance upon opioids. These include the scheduled use of acetaminophen, gabapentinoids, and nonsteroidal anti-inflammatory drugs. In addition, intravenous analgesics such as dexmedetomidine, ketamine, magnesium, and lidocaine have been shown to both complement the maintenance of anesthesia as well as optimize pain control postoperatively. Long-acting opioids remain a key component of pain management when provided to reduce the overall use of short-acting synthetic opioids or in direct response to break though pain after exhausting other alternatives. When applied in a bundled fashion, several studies have demonstrated a reduction in overall opioid administration and improved rates of postoperative recovery. Conclusions: There has been increased awareness regarding the potential short- and long-term adverse effects of both inadequate analgesia and excessive opioid administration after cardiac surgery. This turnkey order set aims to facilitate implementation of a comprehensive approach toward provision of multimodal, opioidsparing medications to optimize pain management in cardiac surgery. (JTCVS Open 2024;22:14-24)
引用
收藏
页码:14 / 24
页数:11
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