[Treatment of postoperative pain in heart surgery]

Postoperative pain ranks among the major problems surgical patients face and it has been taken particularly seriously in recent years. Catecholamine release in response to nociceptive stimulus is associated with higher rates of hemodynamic, respiratory, endocrine, metabolic and immune system complications that worsen the prognosis. Pain after cardiac surgery in the adult has been investigated little, however, probably because it is less intense than pain after thoracotomy. The importance of providing good perioperative analgesia requires us to have an in-depth understanding of the characteristics of such pain, the therapeutic armamentarium available and the technique to be used. Although intravenous analgesia is the most widely applied approach to postoperative pain management, the development of devices for patient controlled analgesia and the advantages of epidural analgesia require us to analyze what the ideal technique might be. The advantages of strict pain control after cardiac surgery oblige us to place greater emphasis on such management among our main postoperative objectives.