Pain and inflammatory response following off-pump coronary artery bypass grafting

Inflammation and pain are two common clinical issues following cardiac surgery, which are important to patient outcomes. This article reviews the literature regarding inflammation and pain following cardiac surgery with special emphasis on off-pump cardiac surgery.

Off-pump surgery is associated with decreased intraoperative inflammatory response compared with procedures using cardiopulmonary bypass; however, the postoperative pattern of inflammatory response is similar to on-pump procedures. Multimodal analgesic regimens and protocol-based approaches to pain management improve analgesia compared to conventional approaches.

Off-pump cardiac surgeries although known to decrease the inflammatory burden do not appear to impact the overall patient outcomes. Recent evidence indicates the prothrombotic tendency following off-pump procedures, which could be related to the time course of inflammation following off-pump cardiac surgery. There might be some benefit of off-pump procedures regarding neurological and renal function that needs further studies. Pain management following off-pump procedures is similar to that of patients undergoing on-pump cardiac surgery. Better caregiver and patient education is crucial for improving pain control following cardiac surgery. Analgesic regimens need to consider adjuvants and regional analgesic techniques and patient-controlled modalities while providing care.