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Effect of Continuous Local Anesthetic in Post-Cardiac Surgery Patients: A Systematic Review
Serena S Hong1,2, Maree A Milross2, Jennifer A Alison2,3
1Physiotherapy Department, Liverpool Hospital, Sydney, New South Wales, Australia.
Insights
Continuous local anesthesia (CLA) infusion after cardiac surgery significantly reduces post-operative pain and shortens the time to ambulation. This method also decreases the need for morphine, improving patient recovery outcomes.
Area of Science:
- Anesthesiology
- Cardiothoracic Surgery
- Pain Management
Background:
- Post-cardiac surgery recovery is often associated with significant pain and delayed ambulation.
- Effective pain management strategies are crucial for improving patient outcomes and reducing hospital stay.
Purpose of the Study:
- To evaluate the impact of continuous local anesthesia (CLA) infusion following cardiac surgery.
- To assess CLA's effect on pain, ambulation, adverse events, patient satisfaction, extubation time, length of stay, narcotic consumption, and pulmonary function.
Main Methods:
- A systematic review and meta-analysis was conducted.
- Searched multiple electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO.
- Included ten eligible trials with 546 participants.
Main Results:
- CLA infusion significantly reduced visual analog pain scores at 72 hours (MD = -14.31 mm) and morphine requirement at 48 hours (MD = -10.19 mg).
- CLA infusion also shortened the time to ambulation (MD = -2.81 hours).
- Insufficient data prevented meta-analysis for severe adverse events, patient satisfaction, and pulmonary function.
Conclusions:
- Continuous local anesthesia infusion post-cardiac surgery effectively reduces pain and morphine consumption.
- It also accelerates patient ambulation, contributing to a smoother recovery.
- Further research is needed to explore effects on adverse events and patient satisfaction.
Objective:
The purpose of this review was to determine the effect of CLA infusion post cardiac surgery on pain, time to ambulation, severe adverse events, patient satisfaction, time to extubation, length of stay in the intensive care unit and in the hospital, total narcotic consumption, and pulmonary function.
Design:
Systematic review with meta-analysis (PROSPERO CRD42014010188).
Methods:
We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; CINAHL; Allied and Complementary Medicine (AMED); and PsycINFO; as well as hand-searching cardiothoracic surgery and anesthetic journals and meeting abstracts.
Results:
Ten eligible trials with a total of 546 participants were identified. Meta-analyses showed that CLA infusion significantly reduced the total mean visual analog pain score at 72 hours (mean difference [MD] = -14.31 mm, 95% confidence interval [CI] = -25.59 to -3.03); time to ambulation (MD = -2.81 hours, 95% CI = -5.23 to -0.4); morphine requirement (MD = -10.19 mg, 95% CI = -11.80 to -8.58) but did not reduce time to ambulate to chair (MD = -1.65 hours, 95% CI = -4.04 to 0.74); time to extubation (MD = -0.18 hours, 95% CI = -1.24 to 0.89); length of ICU stay (MD = 0.9 hours, 95% CI = -2.96 to 4.75); and hospital length of stay (MD = -0.59 days, 95% CI = -1.24 to 0.07). There were insufficient data to perform a meta-analysis on severe adverse events, patient satisfaction, or pulmonary function.
Conclusions:
CLA infusion after cardiac surgery reduces pain score at 72 hours, shortens time to ambulation, and reduces morphine consumption at 48 hours.