Efficacy of a Multimodal Pain Protocol on Postoperative Opioid Use and Pain Reduction for Isolated Coronary Artery...

To investigate whether an ERAS multimodal analgesic regimen reduces postoperative opioid dependence and pain scores in isolated coronary artery bypass grafting (CABG) patients.

Retrospective cohort analysis.

A single institution, a quaternary cardiac center at an academic hospital.

Isolated CABG patients.

A pre-protocol and post-protocol analysis of isolated CABG patients who received a multimodal analgesic protocol in the preoperative, perioperative, and postoperative periods beginning in March 2022.

Postoperative opioid use was measured in morphine milligram equivalents (MME) in the first 72 hours after surgery, and postoperative pain scores were assessed periodically using an 11-point Likert scale. Hospital and intensive care unit (ICU) length of stay were measured as well. Univariate analysis for total opioid use and pain scores was conducted with the Wilcoxon rank-sum test, and multivariate analysis included linear regression with natural log transformation for total opioid use and ordered logistic regression for pain scores. In univariate analysis, post-protocol status was associated with decreased 72-hour opioid use (p < 0.001) and 72-hour pain scores (p = 0.007) compared to pre-protocol status. Similar results were observed in multivariate analysis for both total opioid use (exponentiated coefficient, 0.58; 95% confidence interval [CI], 0.46-0.72) and 72-hour pain scores (adjusted odds ratio, 0.66; 95% CI, 0.45-0.97). ICU length of stay showed no significant difference between cohorts per multivariate Cox proportional hazards regression analysis, but hospital length of stay was significantly longer for the post-protocol cohort compared to the pre-protocol cohort (p = 0.037).

After implementation of an ERAS multimodal analgesic protocol for isolated CABG patients, reduced opioid consumption and pain scores were observed but with an associated increased hospital length of stay. Improving on and broadening the use of these protocols may reduce opioid dependence contributing to the opioid epidemic, but further studies are needed to determine whether a causal relationship underlies the study findings.