Pain after cardiac surgery

Background

Acute pain is common after cardiac surgery and can keep patients from participating in activities that prevent postoperative complications especially respiratory complications. Accurate assessment and understanding of pain are vital for providing satisfactory pain control and optimizing recovery. This study was performed to find the location, distribution, and intensity of pain in a sample of adult cardiac surgery patients during their postoperative ICU stay.

Methods

In a prospective study, pain location, distribution (number of pain areas per patient), and intensity (0–10 numerical rating scale) were documented on 250 consecutive adult patients on the first, second and third postoperative day (POD). Patient characteristics (age, sex, size, and body mass index) were analyzed for their impact on pain intensity. There were 140 male and 110 female patients, with a mean ± SD age of 65.7 ± 13.5 years.

Results

The maximal pain intensity was significantly higher on POD 1 and 2 (3.7 ± 2 and 3.9 ± 1.9, respectively) and lower on POD 3 (3.2 ± 1.5). The order of overall pain scores among activities (P < 0.001) from highest to lowest was coughing, moving or turning in bed, getting up, deep breathing or using the incentive spirometer, and resting. After chest tubes were discontinued, patients had lower pain levels at rest (P = 0.01), with coughing (P = 0.05). Age and sex was found to have an impact on pain intensity, with patients <60 years old and male patients having a higher pain intensity than older patients on POD 2 (4.7 ± 2.0 vs 3.2 ± 2.4, P = 0.02 and 4.5 ± 2.3 vs 2.9 ± 2.2, respectively).

Conclusion

Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain. We recommend the use of remifentanil infusion for postoperative pain relief in suitable cardiac surgery patients.