Assessment of a multimodal analgesia protocol to allow the implementation of enhanced recovery after cardiac surgery: Retrospective analysis of patient outcomes

Study objective: To investigate the impact of utilizing a multimodal analgesia protocol to allow the implementation of Enhanced Recovery after Cardiac Surgery (ERACS) in patients requiring cardio-pulmonary bypass. Design: Retrospective analysis of patients treated with the proposed ERACS bundle in comparison to matched controls. Setting: Single-center study. Patients: A total of 50 patients undergoing elective cardiac surgery limited to on pump coronary artery bypass graft. Measurements: Perioperative outcomes of 25 patients that underwent ERACS protocol and 25 controls were measured. In-operating room (OR) extubation, total intubation time, total intra-OP fentanyl given, total post-OP morphine equivalent given, intensive care unit (ICU) length of stay (LOS), hospital LOS and post-OP complications were examined. Main results: The ERACS group and control group were equivalent with regards to age, gender, comorbidities, ASA classification and type of surgery. Mean cardiac bypass time and mean aortic clamp time were similar. Extubation in the OR was achieved for 12 patients in the ERACS group compared to 1 in the control group. Postoperative opioid consumption was lower in ERACS group (27.3 vs. 51.7 morphine equivalents, p=0.006). Although ICU LOS and hospital LOS were shorter in the ERACS group, this did not reach significance. Conclusions: The ERACS group showed a significant decrease in opioid use and increased incidence of successful in OR extubation.