Coronary Artery Bypass Grafting Using Two Different Anesthetic Techniques: Postoperative Outcome

This study was performed to investigate the effect of prescribing remifentanil, along with paracetamol and gabapentin in comparison of fentanyl and morphine, on pain relief and faster recovery of patients undergoing coronary artery bypass graft (CABG).

A double-blind controlled randomized clinical trial study was performed on 60 CABG candidates. In the control group, the patients underwent anesthesia drugs, analgesic drugs (fentanyl and morphine), and muscle relaxant drugs (without premedication with paracetamol, gabapentin, and remifentanil). In the intervention group, in addition to the control group medications, and bolus doses of remifentanil were used as an analgesic during the operation if analgesia was needed. Also, gabapentin 300 mg orally 1 h before surgery; gabapentin 300 mg every 8 h in the ICU; paracetamol 1 g as an intravenous infusion 30 min before the induction of anesthesia; Paracetamol 1 g every 6 h in the ICU for 3 days were prescribed.

The pain scores mean in the intervention group on the first, second, and third days after CABG were significantly lower than the control group (P < 0.05). Also, the percentage of delirium in the control group was significantly higher than the intervention group in the first and second days after CABG (P < 0.05).

According to the results, administration of remifentanil as a short-acting intraoperative opioid, and the gabapentin to treat nerve pain along with paracetamol before and after CABG surgery could effectively control pain and hemodynamic stability of patients with the least side effects besides reducing the need for additional opioids.