Management of analgesia in cardiac surgery

Pain management in cardiac surgery remains a critical component of perioperative care, influencing recovery, patient satisfaction, and outcomes. Traditional opioid-based analgesia is associated with significant adverse effects, prompting the exploration of multimodal strategies, including regional anesthesia (RA), non-opioid analgesics, and enhanced recovery after surgery (ERAS) protocols.This review evaluates the evolution of cardiac surgery pain management, from conventional opioid-based regimens to multimodal approaches with regional anesthesia.

A comprehensive analysis of existing literature was conducted, assessing the efficacy, safety, and integration of different pain management strategies in cardiac surgery on PubMed, Google Scholar, MEDLINE, UpToDate, Embase and Web of Science until 1 November 2024. Studies on opioids, adjunct analgesics (e.g. NSAIDs, acetaminophen, ketamine, dexmedetomidine), RA techniques, and ERAS frameworks were reviewed to provide a comparative perspective.

Multimodal analgesia significantly reduces opioid consumption, enhances pain control, and minimizes complications such as respiratory depression and postoperative nausea. RA techniques, including fascial plane blocks, offer promising opioid-sparing benefits. ERAS protocols further optimize recovery, yet challenges remain in standardizing approaches across institutions.

The future of cardiac surgery pain management lies in individualized, multimodal strategies following ERAS principles. Standardized guidelines and further research are needed to refine these protocols for widespread adoption.