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Postoperative Critical Care for Cardiac Surgical Patients pp 257–294Cite as

Postoperative Pain Management in Cardiac Surgery

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Abstract

Postoperative pain management is not only a medical concern but also among the human rights; this challenging issue would be much more difficult in postoperative period of cardiac surgery patients in whom the burden of the cardiac disease and the complex perioperative events impose their heavy shadow on the decision-making process for selection of analgesic remedies for acute pain suppression.

In this chapter, a brief discussion about the pathologic mechanisms of pain and their possible risk factors and potential mechanisms is presented first, and then, analgesia methods are discussed in two main categories: pharmacologic methods (including opioids, alpha 2 agonists, nonsteroidal anti-inflammatory drugs “NSAIDs,” paracetamol, ketamine, MgSO4, gabapentin, pregabalin, multimodal analgesia, and patient-controlled analgesia) and non-pharmacologic interventions (mainly infiltration of local anesthetics, intercostal nerve block, intrapleural infiltration of local anesthetics, and neuraxial blocks, “paravertebral, intrathecal, thoracic epidural”).

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References

  • (2012) Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 116:248–273

    Google Scholar 

  • Acharya M, Dunning J (2010) Does the use of non-steroidal anti-inflammatory drugs after cardiac surgery increase the risk of renal failure? Interact Cardiovasc Thorac Surg 11:461–467

    PubMed  Google Scholar 

  • Aida N, Shibuya M, Yoshino K, Komoda M, Inoue T (2002) Respiratory muscle stretch gymnastics in patients with post coronary artery bypass grafting pain: impact on respiratory muscle function, activity, mood and exercise capacity. J Med Dent Sci 49:157–170

    PubMed  Google Scholar 

  • Aldington S, Shirtcliffe P, Weatherall M, Beasley R (2005) Increased risk of cardiovascular events with parecoxib/valdecoxib: a systematic review and meta-analysis. N Z Med J 118:U1755

    PubMed  Google Scholar 

  • Allegaert K, Tibboel D, van den Anker J (2013) Pharmacological treatment of neonatal pain: in search of a new equipoise. Semin Fetal Neonatal Med 18:42–47

    PubMed  Google Scholar 

  • Anderson PG, Cutshall SM (2007) Massage therapy: a comfort intervention for cardiac surgery patients. Clin Nurse Spec 21:161–165, quiz 166–167

    PubMed  Google Scholar 

  • Andrieu G, Roth B, Ousmane L, Castaner M, Petillot P, Vallet B, Villers A, Lebuffe G (2009) The efficacy of intrathecal morphine with or without clonidine for postoperative analgesia after radical prostatectomy. Anesth Analg 108:1954–1957

    PubMed  CAS  Google Scholar 

  • Angst MS, Lazzeroni LC, Phillips NG, Drover DR, Tingle M, Ray A, Swan GE, Clark JD (2012) Aversive and reinforcing opioid effects: a pharmacogenomic twin study. Anesthesiology 117:22–37

    PubMed  CAS  Google Scholar 

  • Aslan FE, Badir A, Arli SK, Cakmakci H (2009) Patients’ experience of pain after cardiac surgery. Contemp Nurse 34:48–54

    PubMed  Google Scholar 

  • Awad H, Abas M, Elgharably H, Tripathi R, Theofilos T, Bhandary S, Sai-Sudhakar C, Sen CK, Roy S (2012) Endogenous opioids in wound-site neutrophils of sternotomy patients. PLoS One 7:e47569

    PubMed  CAS  Google Scholar 

  • Azzopardi S, Lee G (2009) Health-related quality of life 2 years after coronary artery bypass graft surgery. J Cardiovasc Nurs 24:232–240

    PubMed  Google Scholar 

  • Bainbridge D, Cheng DC, Martin JE, Novick R (2006a) NSAID-analgesia, pain control and morbidity in cardiothoracic surgery. Can J Anaesth 53:46–59

    PubMed  Google Scholar 

  • Bainbridge D, Martin JE, Cheng DC (2006b) Patient-controlled versus nurse-controlled analgesia after cardiac surgery–a meta-analysis. Can J Anaesth 53:492–499

    PubMed  Google Scholar 

  • Ballan A, Lee G (2007) A comparative study of patient perceived quality of life pre and post coronary artery bypass graft surgery. Aust J Adv Nurs 24:24–28

    PubMed  Google Scholar 

  • Bar-El Y, Gilboa B, Unger N, Pud D, Eisenberg E (2005) Skeletonized versus pedicled internal mammary artery: impact of surgical technique on post CABG surgery pain. Eur J Cardiothorac Surg 27:1065–1069

    PubMed  Google Scholar 

  • Barletta JF (2012) Clinical and economic burden of opioid use for postsurgical pain: focus on ventilatory impairment and ileus. Pharmacotherapy 32:12S–18S

    PubMed  Google Scholar 

  • Barr AM, Tutungi E, Almeida AA (2007) Parasternal intercostal block with ropivacaine for pain management after cardiac surgery: a double-blind, randomized, controlled trial. J Cardiothorac Vasc Anesth 21:547–553

    PubMed  CAS  Google Scholar 

  • Bedirli N, Akyurek N, Kurtipek O, Kavutcu M, Kartal S, Bayraktar AC (2011) Thoracic epidural bupivacaine attenuates inflammatory response, intestinal lipid peroxidation, oxidative injury, and mucosal apoptosis induced by mesenteric ischemia/reperfusion. Anesth Analg 113:1226–1232

    PubMed  CAS  Google Scholar 

  • Bell G, Dickson U, Arana A, Robinson D, Marshall C, Morton N (2004) Remifentanil vs fentanyl/morphine for pain and stress control during pediatric cardiac surgery. Paediatr Anaesth 14:856–860

    PubMed  CAS  Google Scholar 

  • Bell RF, Dahl JB, Moore RA, Kalso E (2006) Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev:CD004603

    Google Scholar 

  • Bennett GM, Stanley TH (1979) Cardiovascular effects of fentanyl during enflurane anesthesia in man. Anesth Analg 58:179–182

    PubMed  CAS  Google Scholar 

  • Blaudszun G, Lysakowski C, Elia N, Tramer MR (2012) Effect of perioperative systemic alpha2 agonists on postoperative morphine consumption and pain intensity: systematic review and meta-analysis of randomized controlled trials. Anesthesiology 116:1312–1322

    PubMed  CAS  Google Scholar 

  • Bodnar RJ (2011) Endogenous opiates and behavior: 2010. Peptides 32(12):2522–2552

    PubMed  CAS  Google Scholar 

  • Borgermann J, Kanashnik A, Sossdorf M, Gummert J, Losche W (2010) Individual variability of response and non-response to acetyl salicylic acid after cardiac surgery. Platelets 21:610–615

    PubMed  Google Scholar 

  • Bortsov AV, Millikan RC, Belfer I, Boortz-Marx RL, Arora H, McLean SA (2012) mu-Opioid receptor gene A118G polymorphism predicts survival in patients with breast cancer. Anesthesiology 116:896–902

    PubMed  CAS  Google Scholar 

  • Bosilkovska M, Walder B, Besson M, Daali Y, Desmeules J (2012) Analgesics in patients with hepatic impairment: pharmacology and clinical implications. Drugs 72:1645–1669

    PubMed  CAS  Google Scholar 

  • Boulanger A, Perreault S, Choiniere M, Prieto I, Lavoie C, Laflamme C (2002) Intrathecal morphine after cardiac surgery. Ann Pharmacother 36:1337–1343

    PubMed  CAS  Google Scholar 

  • Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, Pucciani F, Altomare DF, Dodi G, Sciaudone G, Falletto E, Piloni V (2012) Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (Part II: Treatment). World J Gastroenterol 18:4994–5013

    PubMed  Google Scholar 

  • Breivik H, Bang U, Jalonen J, Vigfusson G, Alahuhta S, Lagerkranser M (2010) Nordic guidelines for neuraxial blocks in disturbed haemostasis from the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta Anaesthesiol Scand 54:16–41

    PubMed  CAS  Google Scholar 

  • Brock C, Olesen SS, Olesen AE, Frokjaer JB, Andresen T, Drewes AM (2012) Opioid-induced bowel dysfunction: pathophysiology and management. Drugs 72:1847–1865

    PubMed  CAS  Google Scholar 

  • Brown TJ, Hooper L, Elliott RA, Payne K, Webb R, Roberts C, Rostom A, Symmons D (2006) A comparison of the cost-effectiveness of five strategies for the prevention of non-steroidal anti-inflammatory drug-induced gastrointestinal toxicity: a systematic review with economic modelling. Health Technol Assess 10:iii–iv, xi-xiii, 1–183

    CAS  Google Scholar 

  • Bruce J, Drury N, Poobalan AS, Jeffrey RR, Smith WC, Chambers WA (2003) The prevalence of chronic chest and leg pain following cardiac surgery: a historical cohort study. Pain 104:265–273

    PubMed  CAS  Google Scholar 

  • Buvanendran A, Kroin JS (2009) Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol 22:588–593

    PubMed  Google Scholar 

  • Campos JH (2009) Fast track in thoracic anesthesia and surgery. Curr Opin Anaesthesiol 22:1–3

    PubMed  Google Scholar 

  • Caputo M, Alwair H, Rogers CA, Pike K, Cohen A, Monk C, Tomkins S, Ryder I, Moscariello C, Lucchetti V, Angelini GD (2011) Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: a prospective, randomized, controlled trial. Anesthesiology 114:380–390

    PubMed  CAS  Google Scholar 

  • Carstensen M, Moller AM (2010) Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth 104:401–406

    PubMed  CAS  Google Scholar 

  • Chaney MA (2005a) Cardiac surgery and intrathecal/epidural techniques: at the crossroads? Can J Anaesth 52:783–788

    PubMed  Google Scholar 

  • Chaney MA (2005b) How important is postoperative pain after cardiac surgery? J Cardiothorac Vasc Anesth 19:705–707

    PubMed  Google Scholar 

  • Chaney MA (2006) Intrathecal and epidural anesthesia and analgesia for cardiac surgery. Anesth Analg 102:45–64

    PubMed  CAS  Google Scholar 

  • Chaney MA (2009) Thoracic epidural anaesthesia in cardiac surgery–the current standing. Ann Card Anaesth 12:1–3

    PubMed  Google Scholar 

  • Chaney MA, Labovsky JK (2005) Thoracic epidural anesthesia and cardiac surgery: balancing postoperative risks associated with hematoma formation and thromboembolic phenomenon. J Cardiothorac Vasc Anesth 19:768–771

    PubMed  Google Scholar 

  • Chaney MA, Furry PA, Fluder EM, Slogoff S (1997) Intrathecal morphine for coronary artery bypass grafting and early extubation. Anesth Analg 84:241–248

    PubMed  CAS  Google Scholar 

  • Chaney MA, Nikolov MP, Blakeman BP, Bakhos M (1999) Intrathecal morphine for coronary artery bypass graft procedure and early extubation revisited. J Cardiothorac Vasc Anesth 13:574–578

    PubMed  CAS  Google Scholar 

  • Chaudhary V, Chauhan S, Choudhury M, Kiran U, Vasdev S, Talwar S (2012) Parasternal intercostal block with ropivacaine for postoperative analgesia in pediatric patients undergoing cardiac surgery: a double-blind, randomized, controlled study. J Cardiothorac Vasc Anesth 26:439–442

    PubMed  CAS  Google Scholar 

  • Cogan J (2010) Pain management after cardiac surgery. Semin Cardiothorac Vasc Anesth 14:201–204

    PubMed  Google Scholar 

  • Cuthbert AW (2011) Lubiprostone targets prostanoid EP(4) receptors in ovine airways. Br J Pharmacol 162:508–520

    PubMed  CAS  Google Scholar 

  • Dajani EZ, Islam K (2008) Cardiovascular and gastrointestinal toxicity of selective cyclo-oxygenase-2 inhibitors in man. J Physiol Pharmacol 59(Suppl 2):117–133

    PubMed  Google Scholar 

  • Daly DJ, Myles PS (2009) Update on the role of paravertebral blocks for thoracic surgery: are they worth it? Curr Opin Anaesthesiol 22:38–43

    PubMed  Google Scholar 

  • Dauri M, Faria S, Gatti A, Celidonio L, Carpenedo R, Sabato AF (2009) Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences. Curr Drug Targets 10:716–733

    PubMed  CAS  Google Scholar 

  • Davies RG, Myles PS, Graham JM (2006) A comparison of the analgesic efficacy and side-effects of paravertebral vs epidural blockade for thoracotomy–a systematic review and meta-analysis of randomized trials. Br J Anaesth 96:418–426

    PubMed  CAS  Google Scholar 

  • De Cosmo G, Aceto P, Gualtieri E, Congedo E (2009) Analgesia in thoracic surgery: review. Minerva Anestesiol 75:393–400

    PubMed  Google Scholar 

  • Derry S, Moore RA (2012) Single dose oral celecoxib for acute postoperative pain in adults. Cochrane Database Syst Rev 3, CD004233

    PubMed  Google Scholar 

  • Dick F, Hristic A, Roost-Krahenbuhl E, Aymard T, Weber A, Tevaearai HT, Carrel TP (2011) Persistent sensitivity disorders at the radial artery and saphenous vein graft harvest sites: a neglected side effect of coronary artery bypass grafting procedures. Eur J Cardiothorac Surg 40:221–226

    PubMed  Google Scholar 

  • Djafarzadeh S, Vuda M, Takala J, Jakob SM (2012) Effect of remifentanil on mitochondrial oxygen consumption of cultured human hepatocytes. PLoS One 7:e45195

    PubMed  CAS  Google Scholar 

  • Dolin SJ, Cashman JN, Bland JM (2002) Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 89:409–423

    PubMed  CAS  Google Scholar 

  • Dowling R, Thielmeier K, Ghaly A, Barber D, Boice T, Dine A (2003) Improved pain control after cardiac surgery: results of a randomized, double-blind, clinical trial. J Thorac Cardiovasc Surg 126:1271–1278

    PubMed  CAS  Google Scholar 

  • Due MR, Piekarz AD, Wilson N, Feldman P, Ripsch MS, Chavez S, Yin H, Khanna R, White FA (2012) Neuroexcitatory effects of morphine-3-glucuronide are dependent on Toll-like receptor 4 signaling. J Neuroinflammation 9:200

    PubMed  CAS  Google Scholar 

  • Eason MJ, Wyatt R (1979) Paravertebral thoracic block-a reappraisal. Anaesthesia 34:638–642

    PubMed  CAS  Google Scholar 

  • Eljezi V, Duale C, Azarnoush K, Skrzypczak Y, Sautou V, Pereira B, Tsokanis I, Schoeffler P (2012) The analgesic effects of a bilateral sternal infusion of ropivacaine after cardiac surgery. Reg Anesth Pain Med 37:166–174

    PubMed  CAS  Google Scholar 

  • Engelman E, Marsala C (2013) Efficacy of adding clonidine to intrathecal morphine in acute postoperative pain: meta-analysis. Br J Anaesth 110(1):21–27

    PubMed  CAS  Google Scholar 

  • Eschenroeder AC, Vestal-Laborde AA, Sanchez ES, Robinson SE, Sato-Bigbee C (2012) Oligodendrocyte responses to buprenorphine uncover novel and opposing roles of mu-opioid- and nociceptin/orphanin FQ receptors in cell development: implications for drug addiction treatment during pregnancy. Glia 60:125–136

    PubMed  Google Scholar 

  • Esme H, Apiliogullari B, Duran FM, Yoldas B, Bekci TT (2012) Comparison between intermittent intravenous analgesia and intermittent paravertebral subpleural analgesia for pain relief after thoracotomy. Eur J Cardiothorac Surg 41:10–13

    PubMed  Google Scholar 

  • Everts B, Karlson BW, Herlitz J, Hedner T (1998) Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction. Eur J Pain 2:115–125

    PubMed  CAS  Google Scholar 

  • Farrell C, McConaghy P (2012) Perioperative management of patients taking treatment for chronic pain. BMJ 345:e4148

    PubMed  Google Scholar 

  • Fayaz MK, Abel RJ, Pugh SC, Hall JE, Djaiani G, Mecklenburgh JS (2004) Opioid-sparing effects of diclofenac and paracetamol lead to improved outcomes after cardiac surgery. J Cardiothorac Vasc Anesth 18:742–747

    PubMed  CAS  Google Scholar 

  • Ferasatkish R, Dabbagh A, Alavi M, Mollasadeghi G, Hydarpur E, Moghadam AA, Faritus ZS, Totonchi MZ (2008) Effect of magnesium sulfate on extubation time and acute pain in coronary artery bypass surgery. Acta Anaesthesiol Scand 52:1348–1352

    PubMed  CAS  Google Scholar 

  • Frampton C, Quinlan J (2009) Evidence for the use of non-steroidal anti-inflammatory drugs for acute pain in the post anaesthesia care unit. J Perioper Pract 19:418–423

    PubMed  Google Scholar 

  • Fujita T, Kumamoto E (2006) Inhibition by endomorphin-1 and endomorphin-2 of excitatory transmission in adult rat substantia gelatinosa neurons. Neuroscience 139:1095–1105

    PubMed  CAS  Google Scholar 

  • Furue H, Katafuchi T, Yoshimura M (2004) Sensory processing and functional reorganization of sensory transmission under pathological conditions in the spinal dorsal horn. Neurosci Res 48:361–368

    PubMed  Google Scholar 

  • Futier E, Chanques G, Cayot Constantin S, Vernis L, Barres A, Guerin R, Chartier C, Perbet S, Petit A, Jabaudon M, Bazin JE, Constantin JM (2012) Influence of opioid choice on mechanical ventilation duration and ICU length of stay. Minerva Anestesiol 78:46–53

    PubMed  CAS  Google Scholar 

  • Gallagher R, McKinley S, Dracup K (2004) Post discharge problems in women recovering from coronary artery bypass graft surgery. Aust Crit Care 17:160–165

    PubMed  Google Scholar 

  • Gandhi K, Heitz JW, Viscusi ER (2011) Challenges in acute pain management. Anesthesiol Clin 29:291–309

    PubMed  Google Scholar 

  • Garvin S, Muehlschlegel JD, Perry TE, Chen J, Liu KY, Fox AA, Collard CD, Aranki SF, Shernan SK, Body SC (2010) Postoperative activity, but not preoperative activity, of antithrombin is associated with major adverse cardiac events after coronary artery bypass graft surgery. Anesth Analg 111:862–869

    PubMed  CAS  Google Scholar 

  • Gehling M, Tryba M (2009) Risks and side-effects of intrathecal morphine combined with spinal anaesthesia: a meta-analysis. Anaesthesia 64:643–651

    PubMed  CAS  Google Scholar 

  • Geller AS (2011) Opioid overdose-related deaths. JAMA 306:379; author reply 380–371

    PubMed  CAS  Google Scholar 

  • George JA, Lin EE, Hanna MN, Murphy JD, Kumar K, Ko PS, Wu CL (2010) The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J Opioid Manag 6:47–54

    PubMed  Google Scholar 

  • Gjeilo KH, Klepstad P, Wahba A, Lydersen S, Stenseth R (2010) Chronic pain after cardiac surgery: a prospective study. Acta Anaesthesiol Scand 54:70–78

    PubMed  CAS  Google Scholar 

  • Glaser AM, Reyes-Vazquez C, Prieto-Gomez B, Burau K, Dafny N (2012) Morphine administration and abrupt cessation alter the behavioral diurnal activity pattern. Pharmacol Biochem Behav 101:544–552

    PubMed  CAS  Google Scholar 

  • Granier S, Manglik A, Kruse AC, Kobilka TS, Thian FS, Weis WI, Kobilka BK (2012) Structure of the delta-opioid receptor bound to naltrindole. Nature 485:400–404

    PubMed  CAS  Google Scholar 

  • Graterol J, Linter SP (2012) The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 26:e26; author reply e26

    PubMed  CAS  Google Scholar 

  • Greenfield GT, Whitworth WA, Tavares LL, Wittenbraker MT, Wallace DM, Valdivia JA, Campbell K, Williams L, Black E, Pillai R, Caskey MP, Bladergroen MR (2001) Minimally invasive vein harvest and wound healing using the SaphLITE Retractor System. Ann Thorac Surg 72:S1046–S1049

    PubMed  CAS  Google Scholar 

  • Griesdale DE, Neufeld J, Dhillon D, Joo J, Sandhu S, Swinton F, Choi PT (2011) Risk factors for urinary retention after hip or knee replacement: a cohort study. Can J Anaesth 58:1097–1104

    PubMed  Google Scholar 

  • Griffin MR (1998) Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 104:23S–29S; discussion 41S–42S

    PubMed  CAS  Google Scholar 

  • Gu WJ, Wei CY, Huang DQ, Yin RX (2012) Meta-analysis of randomized controlled trials on the efficacy of thoracic epidural anesthesia in preventing atrial fibrillation after coronary artery bypass grafting. BMC Cardiovasc Disord 12:67

    PubMed  Google Scholar 

  • Guggenberger H, Schroeder TH, Vonthein R, Dieterich HJ, Shernan SK, Eltzschig HK (2006) Remifentanil or sufentanil for coronary surgery: comparison of postoperative respiratory impairment. Eur J Anaesthesiol 23:832–840

    PubMed  CAS  Google Scholar 

  • Guo P, East L, Arthur A (2012) A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud 49:129–137

    PubMed  Google Scholar 

  • Hachenberg T (2000) Perioperative management with short-acting intravenous anesthetics. Anaesthesiol Reanim 25:144–150

    PubMed  CAS  Google Scholar 

  • Hanna MH, Elliott KM, Fung M (2005) Randomized, double-blind study of the analgesic efficacy of morphine-6-glucuronide versus morphine sulfate for postoperative pain in major surgery. Anesthesiology 102:815–821

    PubMed  CAS  Google Scholar 

  • Hassan I, Jacobs AG, Baig ME, Van der Meyden CH (2006) Bilateral axillary and suprascapular neuropathy after coronary artery bypass surgery. Cardiovasc J S Afr 17:259–261

    PubMed  CAS  Google Scholar 

  • Herr DL, Sum-Ping ST, England M (2003) ICU sedation after coronary artery bypass graft surgery: dexmedetomidine-based versus propofol-based sedation regimens. J Cardiothorac Vasc Anesth 17:576–584

    PubMed  Google Scholar 

  • Hertle DN, Dreier JP, Woitzik J, Hartings JA, Bullock R, Okonkwo DO, Shutter LA, Vidgeon S, Strong AJ, Kowoll C, Dohmen C, Diedler J, Veltkamp R, Bruckner T, Unterberg AW, Sakowitz OW (2012) Effect of analgesics and sedatives on the occurrence of spreading depolarizations accompanying acute brain injury. Brain 135:2390–2398

    PubMed  Google Scholar 

  • Hicks RW, Hernandez J, Wanzer LJ (2012) Perioperative pharmacology: patient-controlled analgesia. AORN J 95:255–262, quiz 263–255

    PubMed  Google Scholar 

  • Hirose H, Amano A, Takanashi S, Takahashi A (2003) Skeletonized bilateral internal mammary artery grafting for patients with diabetes. Interact Cardiovasc Thorac Surg 2:287–292

    PubMed  Google Scholar 

  • Hogue CW Jr, Talke P, Stein PK, Richardson C, Domitrovich PP, Sessler DI (2002) Autonomic nervous system responses during sedative infusions of dexmedetomidine. Anesthesiology 97:592–598

    PubMed  CAS  Google Scholar 

  • Holzer P (2012) Non-analgesic effects of opioids: management of opioid-induced constipation by peripheral opioid receptor antagonists: prevention or withdrawal? Curr Pharm Des 18(37):6010–6020

    PubMed  CAS  Google Scholar 

  • Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, Brown DL, Heit JA, Mulroy MF, Rosenquist RW, Tryba M, Yuan CS (2010) Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition). Reg Anesth Pain Med 35:64–101

    PubMed  CAS  Google Scholar 

  • Hudcova J, McNicol E, Quah C, Lau J, Carr DB (2006) Patient controlled opioid analgesia versus conventional opioid analgesia for postoperative pain. Cochrane Database Syst Rev:CD003348

    Google Scholar 

  • Hudson RJ, Thomson IR, Henderson BT, Singh K, Harding G, Peterson DJ (2002) Validation of fentanyl pharmacokinetics in patients undergoing coronary artery bypass grafting. Can J Anaesth 49:388–392

    PubMed  Google Scholar 

  • Huffmyer J, Tashjian J, Raphael J, Jaeger JM (2012) Management of the patient for transcatheter aortic valve implantation in the perioperative period. Semin Cardiothorac Vasc Anesth 16:25–40

    PubMed  Google Scholar 

  • Hughes MM, Atayee RS, Best BM, Pesce AJ (2012) Observations on the metabolism of morphine to hydromorphone in pain patients. J Anal Toxicol 36:250–256

    PubMed  CAS  Google Scholar 

  • Hutchinson MR, Northcutt AL, Hiranita T, Wang X, Lewis SS, Thomas J, van Steeg K, Kopajtic TA, Loram LC, Sfregola C, Galer E, Miles NE, Bland ST, Amat J, Rozeske RR, Maslanik T, Chapman TR, Strand KA, Fleshner M, Bachtell RK, Somogyi AA, Yin H, Katz JL, Rice KC, Maier SF, Watkins LR (2012) Opioid activation of toll-like receptor 4 contributes to drug reinforcement. J Neurosci 32:11187–11200

    PubMed  CAS  Google Scholar 

  • Ing Lorenzini K, Daali Y, Dayer P, Desmeules J (2012) Pharmacokinetic-pharmacodynamic modelling of opioids in healthy human volunteers.A minireview. Basic Clin Pharmacol Toxicol 110:219–226

    PubMed  Google Scholar 

  • International Pain Summit of the International Association for the Study of Pain (2011) Declaration of Montreal: declaration that access to pain management is a fundamental human right. J Pain Palliat Care Pharmacother 25:29–31

    PubMed  CAS  Google Scholar 

  • Ishihara M, Ikesue H, Matsunaga H, Suemaru K, Kitaichi K, Suetsugu K, Oishi R, Sendo T, Araki H, Itoh Y (2012) A multi-institutional study analyzing effect of prophylactic medication for prevention of opioid-induced gastrointestinal dysfunction. Clin J Pain 28:373–381

    PubMed  Google Scholar 

  • Ishii Y, Iida N, Miyauchi Y, Mackenzie PI, Yamada H (2012) Inhibition of morphine glucuronidation in the liver microsomes of rats and humans by monoterpenoid alcohols. Biol Pharm Bull 35:1811–1817

    PubMed  CAS  Google Scholar 

  • Jacobsohn E, Lee TW, Amadeo RJ, Syslak PH, Debrouwere RG, Bell D, Klock PA, Tymkew H, Avidan M (2005) Low-dose intrathecal morphine does not delay early extubation after cardiac surgery. Can J Anaesth 52:848–857

    PubMed  Google Scholar 

  • James MF (2009) Magnesium: an emerging drug in anaesthesia. Br J Anaesth 103:465–467

    PubMed  CAS  Google Scholar 

  • Jayr C (1998) Repercussion of postoperative pain, benefits attending to treatment. Ann Fr Anesth Reanim 17:540–554

    PubMed  CAS  Google Scholar 

  • Jeleazcov C, Saari TI, Ihmsen H, Schuttler J, Fechner J (2012) Changes in total and unbound concentrations of sufentanil during target controlled infusion for cardiac surgery with cardiopulmonary bypass. Br J Anaesth 109:698–706

    PubMed  CAS  Google Scholar 

  • Jonjev Z, Selestiansky J, Redzek A, Radovanovic N (2000) Myocardial revascularization with skeletonized left mammary artery. Med Pregl 53:174–179

    PubMed  CAS  Google Scholar 

  • Jungquist CR, Karan S, Perlis ML (2011) Risk factors for opioid-induced excessive respiratory depression. Pain Manag Nurs 12:180–187

    PubMed  Google Scholar 

  • Jurna I (2003) Serturner and morphine–a historical vignette. Schmerz 17:280–283

    PubMed  CAS  Google Scholar 

  • Kalso E, Mennander S, Tasmuth T, Nilsson E (2001) Chronic post-sternotomy pain. Acta Anaesthesiol Scand 45:935–939

    PubMed  CAS  Google Scholar 

  • Kapila A, Glass PS, Jacobs JR, Muir KT, Hermann DJ, Shiraishi M, Howell S, Smith RL (1995) Measured context-sensitive half-times of remifentanil and alfentanil. Anesthesiology 83:968–975

    PubMed  CAS  Google Scholar 

  • Kapoor S (2012) Opioid/naloxone prolonged release combinations for opioid induced constipation. World J Gastroenterol 18:3921–3922

    PubMed  CAS  Google Scholar 

  • Karagoz HY, Sonmez B, Bakkaloglu B, Kurtoglu M, Erdinc M, Turkeli A, Bayazit K (2000) Coronary artery bypass grafting in the conscious patient without endotracheal general anesthesia. Ann Thorac Surg 70:91–96

    PubMed  CAS  Google Scholar 

  • Katz J, Seltzer Z (2009) Transition from acute to chronic postsurgical pain: risk factors and protective factors. Expert Rev Neurother 9:723–744

    PubMed  Google Scholar 

  • Kehlet H, Dahl JB (1993) The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg 77:1048–1056

    PubMed  CAS  Google Scholar 

  • Khan M, Fraser A (2012) Cox-2 inhibitors and the risk of cardiovascular thrombotic events. Ir Med J 105:119–121

    PubMed  CAS  Google Scholar 

  • Kiani S, Poston R (2011) Is endoscopic harvesting bad for saphenous vein graft patency in coronary surgery? Curr Opin Cardiol 26:518–522

    PubMed  Google Scholar 

  • Klockgether-Radke AP (2002) F. W. Serturner and the discovery of morphine. 200 years of pain therapy with opioids. Anasthesiol Intensivmed Notfallmed Schmerzther 37:244–249

    PubMed  CAS  Google Scholar 

  • Kocabas S, Yedicocuklu D, Yuksel E, Uysallar E, Askar F (2008) Infiltration of the sternotomy wound and the mediastinal tube sites with 0.25% levobupivacaine as adjunctive treatment for postoperative pain after cardiac surgery. Eur J Anaesthesiol 25:842–849

    PubMed  CAS  Google Scholar 

  • Koukis I, Argiriou M, Dimakopoulou A, Panagiotakopoulos V, Theakos N, Charitos C (2008) Use of continuous subcutaneous anesthetic infusion in cardiac surgical patients after median sternotomy. J Cardiothorac Surg 3:2

    PubMed  Google Scholar 

  • Kwok YH, Hutchinson MR, Gentgall MG, Rolan PE (2012) Increased responsiveness of peripheral blood mononuclear cells to in vitro TLR 2, 4 and 7 ligand stimulation in chronic pain patients. PLoS One 7:e44232

    PubMed  CAS  Google Scholar 

  • Lahtinen P, Kokki H, Hendolin H, Hakala T, Hynynen M (2002) Propacetamol as adjunctive treatment for postoperative pain after cardiac surgery. Anesth Analg 95:813–819, table of contents

    PubMed  CAS  Google Scholar 

  • Lahtinen P, Kokki H, Hakala T, Hynynen M (2004) S(+)-ketamine as an analgesic adjunct reduces opioid consumption after cardiac surgery. Anesth Analg 99:1295–1301; table of contents

    PubMed  CAS  Google Scholar 

  • Lahtinen P, Kokki H, Hynynen M (2006) Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology 105:794–800

    PubMed  Google Scholar 

  • Lahtinen P, Kokki H, Hynynen M (2008) Remifentanil infusion does not induce opioid tolerance after cardiac surgery. J Cardiothorac Vasc Anesth 22:225–229

    PubMed  CAS  Google Scholar 

  • Langford RM, Mehta V (2006) Selective cyclooxygenase inhibition: its role in pain and anaesthesia. Biomed Pharmacother 60:323–328

    PubMed  CAS  Google Scholar 

  • Laorden ML, Ferenczi S, Pinter-Kubler B, Gonzalez-Martin LL, Lasheras MC, Kovacs KJ, Milanes MV, Nunez C (2012) Hypothalamic orexin–a neurons are involved in the response of the brain stress system to morphine withdrawal. PLoS One 7:e36871

    PubMed  CAS  Google Scholar 

  • Leal EN, Ribeiro JL, Oliveira MM, Roquette J (2005) Psychosocial aspects associated with pain perception in individuals undergoing coronary surgery. Rev Port Cardiol 24:1221–1231

    PubMed  Google Scholar 

  • Ledowski T, Stein J, Albus S, MacDonald B (2011) The influence of age and sex on the relationship between heart rate variability, haemodynamic variables and subjective measures of acute post-operative pain. Eur J Anaesthesiol 28:433–437

    PubMed  Google Scholar 

  • Ledowski T, Reimer M, Chavez V, Kapoor V, Wenk M (2012) Effects of acute postoperative pain on catecholamine plasma levels, hemodynamic parameters, and cardiac autonomic control. Pain 153:759–764

    PubMed  CAS  Google Scholar 

  • Lee GA (2008) Patients reported health-related quality of life five years post coronary artery bypass graft surgery–a methodological study. Eur J Cardiovasc Nurs 7:67–72

    PubMed  Google Scholar 

  • Lee W, Yan YY, Jensen MP, Shun SC, Lin YK, Tsai TP, Lai YH (2010) Predictors and patterns of chronic pain three months after cardiac surgery in Taiwan. Pain Med 11:1849–1858

    PubMed  Google Scholar 

  • Lena P, Balarac N, Lena D, De La Chapelle A, Arnulf JJ, Mihoubi A, Tapia M, Bonnet F (2008) Fast-track anesthesia with remifentanil and spinal analgesia for cardiac surgery: the effect on pain control and quality of recovery. J Cardiothorac Vasc Anesth 22:536–542

    PubMed  CAS  Google Scholar 

  • Leung K (2004a) [6-O-methyl-11C]Diprenorphine

    Google Scholar 

  • Leung K (2004b) (20R)-4,5-alpha-Epoxy-17-methyl-3-hydroxy-6-[11C]methoxy-alpha,17-dimethyl-alpha- (2-phenylethyl)-6,14-ethenomorphinan-7-methanol

    Google Scholar 

  • Lewis SS, Loram LC, Hutchinson MR, Li CM, Zhang Y, Maier SF, Huang Y, Rice KC, Watkins LR (2012) (+)-naloxone, an opioid-inactive toll-like receptor 4 signaling inhibitor, reverses multiple models of chronic neuropathic pain in rats. J Pain 13:498–506

    PubMed  CAS  Google Scholar 

  • Lima Canadas PP, Canas AC, Orradre Romeo JL, Rubio Martinez CI, Lopez Almodovar LF, Calleja HM (2005) Endothelium histological integrity after skeletonized dissection of the left internal mammary artery with ultrasonic scalpel. Interact Cardiovasc Thorac Surg 4:160–162

    PubMed  Google Scholar 

  • Lin Y, He B, Chen J, Wang Z (2012) Can dexmedetomidine be a safe and efficacious sedative agent in post-cardiac surgery patients: a meta-analysis? Crit Care 16:R169

    PubMed  Google Scholar 

  • Lippe PM, Brock C, David J, Crossno R, Gitlow S (2010) The First National Pain Medicine Summit–final summary report. Pain Med 11:1447–1468

    PubMed  Google Scholar 

  • Liu SS, Wu CL (2007) Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence. Anesth Analg 104:689–702

    PubMed  CAS  Google Scholar 

  • Liu SS, Block BM, Wu CL (2004) Effects of perioperative central neuraxial analgesia on outcome after coronary artery bypass surgery: a meta-analysis. Anesthesiology 101:153–161

    PubMed  CAS  Google Scholar 

  • Loboz KK, Shenfield GM (2005) Drug combinations and impaired renal function – the ‘triple whammy’. Br J Clin Pharmacol 59:239–243

    PubMed  CAS  Google Scholar 

  • Lotsch J (2005) Pharmacokinetic-pharmacodynamic modeling of opioids. J Pain Symptom Manage 29:S90–S103

    PubMed  Google Scholar 

  • Macintyre PE, Loadsman JA, Scott DA (2011) Opioids, ventilation and acute pain management. Anaesth Intensive Care 39:545–558

    PubMed  CAS  Google Scholar 

  • Mansouri M, Bageri K, Noormohammadi E, Mirmohammadsadegi M, Mirdehgan A, Ahangaran AG (2011) Randomized controlled trial of bilateral intrapleural block in cardiac surgery. Asian Cardiovasc Thorac Ann 19:133–138

    PubMed  Google Scholar 

  • Mathews ET, Abrams LD (1980) Intrathecal morphine in open heart surgery. Lancet 2:543

    PubMed  CAS  Google Scholar 

  • Mathews TJ, Churchhouse AM, Housden T, Dunning J (2012) Does adding ketamine to morphine patient-controlled analgesia safely improve post-thoracotomy pain? Interact Cardiovasc Thorac Surg 14:194–199

    PubMed  Google Scholar 

  • Maund E, McDaid C, Rice S, Wright K, Jenkins B, Woolacott N (2011) Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs for the reduction in morphine-related side-effects after major surgery: a systematic review. Br J Anaesth 106:292–297

    PubMed  CAS  Google Scholar 

  • May G, Bartram T (2007) Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. The use of intrapleural anaesthetic to reduce the pain of chest drain insertion. Emerg Med J 24:300–301

    PubMed  Google Scholar 

  • Mazzeffi M, Khelemsky Y (2011) Poststernotomy pain: a clinical review. J Cardiothorac Vasc Anesth 25:1163–1178

    PubMed  Google Scholar 

  • McCormack PL (2011) Celecoxib: a review of its use for symptomatic relief in the treatment of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. Drugs 71:2457–2489

    PubMed  CAS  Google Scholar 

  • McDaid C, Maund E, Rice S, Wright K, Jenkins B, Woolacott N (2010) Paracetamol and selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) for the reduction of morphine-related side effects after major surgery: a systematic review. Health Technol Assess 14:1–153, iii–iv

    PubMed  CAS  Google Scholar 

  • McDonald SB, Jacobsohn E, Kopacz DJ, Desphande S, Helman JD, Salinas F, Hall RA (2005) Parasternal block and local anesthetic infiltration with levobupivacaine after cardiac surgery with desflurane: the effect on postoperative pain, pulmonary function, and tracheal extubation times. Anesth Analg 100:25–32

    PubMed  CAS  Google Scholar 

  • Meehan DA, McRae ME, Rourke DA, Eisenring C, Imperial FA (1995) Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients. Am J Crit Care 4:435–442

    PubMed  CAS  Google Scholar 

  • Meylan N, Elia N, Lysakowski C, Tramer MR (2009) Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials. Br J Anaesth 102:156–167

    PubMed  CAS  Google Scholar 

  • Michelet P, Guervilly C, Helaine A, Avaro JP, Blayac D, Gaillat F, Dantin T, Thomas P, Kerbaul F (2007) Adding ketamine to morphine for patient-controlled analgesia after thoracic surgery: influence on morphine consumption, respiratory function, and nocturnal desaturation. Br J Anaesth 99:396–403

    PubMed  CAS  Google Scholar 

  • Milgrom LB, Brooks JA, Qi R, Bunnell K, Wuestfeld S, Beckman D (2004) Pain levels experienced with activities after cardiac surgery. Am J Crit Care 13:116–125

    PubMed  Google Scholar 

  • Moen V (2010) Scandinavian guidelines for neuraxial block and disturbed haemostasis: replacing wishful thinking with evidence based caution. Acta Anaesthesiol Scand 54:6–8

    PubMed  CAS  Google Scholar 

  • Moore SM (1995) A comparison of women’s and men’s symptoms during home recovery after coronary artery bypass surgery. Heart Lung 24:495–501

    PubMed  CAS  Google Scholar 

  • Moore RA, Straube S, Paine J, Derry S, McQuay HJ (2011) Minimum efficacy criteria for comparisons between treatments using individual patient meta-analysis of acute pain trials: examples of etoricoxib, paracetamol, ibuprofen, and ibuprofen/paracetamol combinations after third molar extraction. Pain 152:982–989

    PubMed  CAS  Google Scholar 

  • Mota FA, Marcolan JF, Pereira MH, Milanez AM, Dallan LA, Diccini S (2010) Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery. Rev Bras Cir Cardiovasc 25:38–44

    PubMed  Google Scholar 

  • Muehling BM, Ortlieb L, Oberhuber A, Orend KH (2011) Fast track management reduces the systemic inflammatory response and organ failure following elective infrarenal aortic aneurysm repair. Interact Cardiovasc Thorac Surg 12:784–788

    PubMed  Google Scholar 

  • Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chiolero R, von Segesser LK (2000a) Pain location, distribution, and intensity after cardiac surgery. Chest 118:391–396

    PubMed  CAS  Google Scholar 

  • Mueller XM, Tinguely F, Tevaearai HT, Revelly JP, Chiolero R, von Segesser LK (2000b) Pain pattern and left internal mammary artery grafting. Ann Thorac Surg 70:2045–2049

    PubMed  CAS  Google Scholar 

  • Mugabure Bujedo B (2012) A clinical approach to neuraxial morphine for the treatment of postoperative pain. Pain Res Treat 2012:612145

    PubMed  Google Scholar 

  • Munir MA, Enany N, Zhang JM (2007) Nonopioid analgesics. Anesthesiol Clin 25:761–774, vi

    PubMed  CAS  Google Scholar 

  • Murphy EJ (2005) Acute pain management pharmacology for the patient with concurrent renal or hepatic disease. Anaesth Intensive Care 33:311–322

    PubMed  CAS  Google Scholar 

  • Na ES, Morris MJ, Johnson AK (2012) Opioid mechanisms that mediate the palatability of and appetite for salt in sodium replete and deficient states. Physiol Behav 106:164–170

    PubMed  CAS  Google Scholar 

  • Nikoda VV, Petrov RO, Sandrikov VA, Chizhov AI (1994) Effects of opioid analgesics on pulmonary ventilation and metabolism in patients with acute postoperative pain. Anesteziol Reanimatol 4:28–29

    Google Scholar 

  • Nishimori M, Low JH, Zheng H, Ballantyne JC (2012) Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery. Cochrane Database Syst Rev 7, CD005059

    PubMed  Google Scholar 

  • Oderda G (2012) Challenges in the management of acute postsurgical pain. Pharmacotherapy 32:6S–11S

    PubMed  CAS  Google Scholar 

  • Ogus H, Selimoglu O, Basaran M, Ozcelebi C, Ugurlucan M, Sayin OA, Kafali E, Ogus TN (2007) Effects of intrapleural analgesia on pulmonary function and postoperative pain in patients with chronic obstructive pulmonary disease undergoing coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 21:816–819

    PubMed  Google Scholar 

  • Olofsen E, Boom M, Nieuwenhuijs D, Sarton E, Teppema L, Aarts L, Dahan A (2010a) Modeling the non-steady state respiratory effects of remifentanil in awake and propofol-sedated healthy volunteers. Anesthesiology 112:1382–1395

    PubMed  CAS  Google Scholar 

  • Olofsen E, Mooren R, van Dorp E, Aarts L, Smith T, den Hartigh J, Dahan A, Sarton E (2010b) Arterial and venous pharmacokinetics of morphine-6-glucuronide and impact of sample site on pharmacodynamic parameter estimates. Anesth Analg 111:626–632

    PubMed  CAS  Google Scholar 

  • Ong CK, Lirk P, Tan CH, Seymour RA (2007) An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res 5:19–34

    PubMed  CAS  Google Scholar 

  • Papadopoulos N, Hacibaramoglu M, Kati C, Muller D, Floter J, Moritz A (2013) Chronic poststernotomy pain after cardiac surgery: correlation of computed tomography findings on sternal healing with postoperative chest pain. Thorac Cardiovasc Surg 61(3):202–208

    PubMed  Google Scholar 

  • Parlow JL, Steele RG, O’Reilly D (2005) Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit. Can J Anaesth 52:94–99

    PubMed  Google Scholar 

  • Parry M, Watt-Watson J, Hodnett E, Tranmer J, Dennis CL, Brooks D (2010) Pain experiences of men and women after coronary artery bypass graft surgery. J Cardiovasc Nurs 25:E9–E15

    PubMed  Google Scholar 

  • Peivandi AA, Weigang E, Kayhan N, Hakami L, Ister D, Denk K, Conzelmann LO, Vahl CF (2009) Reevaluation of two techniques of harvesting the skeletonized internal mammary artery. Thorac Cardiovasc Surg 57:214–216

    PubMed  CAS  Google Scholar 

  • Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, Marcus MA, Vlaeyen JW, van Kleef M (2007) Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 245:487–494

    PubMed  Google Scholar 

  • Pettersson PH, Jakobsson J, Owall A (2005) Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting. J Cardiothorac Vasc Anesth 19:306–309

    PubMed  CAS  Google Scholar 

  • Phillips RS, Cleary DR, Nalwalk JW, Arttamangkul S, Hough LB, Heinricher MM (2012) Pain-facilitating medullary neurons contribute to opioid-induced respiratory depression. J Neurophysiol 108(9):2393–2404

    PubMed  Google Scholar 

  • Polanco MJ, Alguacil LF, Gonzalez-Martin C (2012) Pro-apoptotic properties of morphine in neuroblastoma x glioma NG108-15 hybrid cells: modulation by yohimbine. J Appl Toxicol

    Google Scholar 

  • Popping DM, Elia N, Marret E, Remy C, Tramer MR (2008a) Protective effects of epidural analgesia on pulmonary complications after abdominal and thoracic surgery: a meta-analysis. Arch Surg 143:990–999, discussion 1000

    PubMed  Google Scholar 

  • Popping DM, Zahn PK, Van Aken HK, Dasch B, Boche R, Pogatzki-Zahn EM (2008b) Effectiveness and safety of postoperative pain management: a survey of 18 925 consecutive patients between 1998 and 2006 (2nd revision): a database analysis of prospectively raised data. Br J Anaesth 101:832–840

    PubMed  CAS  Google Scholar 

  • Rachinger-Adam B, Conzen P, Azad SC (2011) Pharmacology of peripheral opioid receptors. Curr Opin Anaesthesiol 24:408–413

    PubMed  Google Scholar 

  • Rainsford KD (2007) Anti-inflammatory drugs in the 21st century. Subcell Biochem 42:3–27

    PubMed  CAS  Google Scholar 

  • Rawal N (2012) Epidural technique for postoperative pain: gold standard no more? Reg Anesth Pain Med 37:310–317

    PubMed  Google Scholar 

  • Richardson J, Lonnqvist PA, Naja Z (2011) Bilateral thoracic paravertebral block: potential and practice. Br J Anaesth 106:164–171

    PubMed  CAS  Google Scholar 

  • Romeyke T, Stummer H (2012) Clinical pathways as instruments for risk and cost management in hospitals – a discussion paper. Glob J Health Sci 4:50–59

    PubMed  Google Scholar 

  • Royse CF (2009) High thoracic epidural anaesthesia for cardiac surgery. Curr Opin Anaesthesiol 22:84–87

    PubMed  Google Scholar 

  • Rubens FD, Boodhwani M (2009) Skeletonization of the internal thoracic artery for coronary artery bypass grafting. Curr Opin Cardiol 24:559–566

    PubMed  Google Scholar 

  • Saadat H, Ziai SA, Ghanemnia M, Namazi MH, Safi M, Vakili H, Dabbagh A, Gholami O (2012) Opium addiction increases interleukin 1 receptor antagonist (IL-1Ra) in the coronary artery disease patients. PLoS One 7:e44939

    PubMed  CAS  Google Scholar 

  • Sacerdote P, Franchi S, Panerai AE (2012) Non-analgesic effects of opioids: mechanisms and potential clinical relevance of opioid-induced immunodepression. Curr Pharm Des 18(37):6034–6042

    PubMed  CAS  Google Scholar 

  • Scarci M, Joshi A, Attia R (2010) In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management? Interact Cardiovasc Thorac Surg 10:92–96

    PubMed  Google Scholar 

  • Schachner T, Bonatti J, Balogh D, Margreiter J, Mair P, Laufer G, Putz G (2003) Aortic valve replacement in the conscious patient under regional anesthesia without endotracheal intubation. J Thorac Cardiovasc Surg 125:1526–1527

    PubMed  Google Scholar 

  • Schwann NM, Chaney MA (2003) No pain, much gain? J Thorac Cardiovasc Surg 126:1261–1264

    PubMed  Google Scholar 

  • Scott LJ, Perry CM (2005) Remifentanil: a review of its use during the induction and maintenance of general anaesthesia. Drugs 65:1793–1823

    PubMed  CAS  Google Scholar 

  • Servin F (2003) Remifentanil; from pharmacological properties to clinical practice. Adv Exp Med Biol 523:245–260

    PubMed  CAS  Google Scholar 

  • Servin FS (2008) Update on pharmacology of hypnotic drugs. Curr Opin Anaesthesiol 21:473–477

    PubMed  Google Scholar 

  • Servin FS, Billard V (2008) Remifentanil and other opioids. Handb Exp Pharmacol:283–311

    Google Scholar 

  • Shekar K, Roberts JA, Mullany DV, Corley A, Fisquet S, Bull TN, Barnett AG, Fraser JF (2012) Increased sedation requirements in patients receiving extracorporeal membrane oxygenation for respiratory and cardiorespiratory failure. Anaesth Intensive Care 40:648–655

    PubMed  CAS  Google Scholar 

  • Shi WD, Wang WW, Cui XG, Pan P, Zhang B, Li WZ (2012) Preventive and therapeutic effects of penehyclidine hydrochloride on morphine-induced increased bladder pressure, urinary bladder sphincter pressure and histological damage in rabbits. Chin Med J (Engl) 125:1141–1146

    CAS  Google Scholar 

  • Simpson T, Lee ER, Cameron C (1996) Patients' perceptions of environmental factors that disturb sleep after cardiac surgery. Am J Crit Care 5:173–181

    PubMed  CAS  Google Scholar 

  • Smith TH, Grider JR, Dewey WL, Akbarali HI (2012) Morphine decreases enteric neuron excitability via inhibition of sodium channels. PLoS One 7:e45251

    PubMed  CAS  Google Scholar 

  • Staahl C, Olesen AE, Andresen T, Arendt-Nielsen L, Drewes AM (2009) Assessing analgesic actions of opioids by experimental pain models in healthy volunteers – an updated review. Br J Clin Pharmacol 68:149–168

    PubMed  CAS  Google Scholar 

  • Stoelting RK (1989) Intrathecal morphine–an underused combination for postoperative pain management. Anesth Analg 68:707–709

    PubMed  CAS  Google Scholar 

  • Stritesky M, Semrad M, Kunstyr J, Hajek T, Demes R, Tosovsky J (2004) On-pump cardiac surgery in a conscious patient using a thoracic epidural anesthesia–an ultra fast track method. Bratisl Lek Listy 105:51–55

    PubMed  CAS  Google Scholar 

  • Sultan P, Gutierrez MC, Carvalho B (2011) Neuraxial morphine and respiratory depression: finding the right balance. Drugs 71:1807–1819

    PubMed  CAS  Google Scholar 

  • Suzuki M (2009) Role of N-methyl-D-aspartate receptor antagonists in postoperative pain management. Curr Opin Anaesthesiol 22:618–622

    PubMed  Google Scholar 

  • Svircevic V, Nierich AP, Moons KG, Diephuis JC, Ennema JJ, Brandon Bravo Bruinsma GJ, Kalkman CJ, van Dijk D (2011a) Thoracic epidural anesthesia for cardiac surgery: a randomized trial. Anesthesiology 114:262–270

    PubMed  CAS  Google Scholar 

  • Svircevic V, van Dijk D, Nierich AP, Passier MP, Kalkman CJ, van der Heijden GJ, Bax L (2011b) Meta-analysis of thoracic epidural anesthesia versus general anesthesia for cardiac surgery. Anesthesiology 114:271–282

    PubMed  CAS  Google Scholar 

  • Swartjes M, Mooren RA, Waxman AR, Arout C, Van De Wetering K, Den Hartigh J, Beijnen JH, Kest B, Dahan A (2012) Morphine induces hyperalgesia without involvement of mu-opioid receptor or morphine-3-glucuronide. Mol Med 18:1320–1326

    PubMed  CAS  Google Scholar 

  • Tack J, Corsetti M (2012) Prucalopride: evaluation of the pharmacokinetics, pharmacodynamics, efficacy and safety in the treatment of chronic constipation. Expert Opin Drug Metab Toxicol 8:1327–1335

    PubMed  CAS  Google Scholar 

  • Tenenbaum J (1999) The epidemiology of nonsteroidal anti-inflammatory drugs. Can J Gastroenterol 13:119–122

    PubMed  CAS  Google Scholar 

  • Tennyson C, Young CP, Scarci M (2010) Is it safe to perform endoscopic vein harvest? Interact Cardiovasc Thorac Surg 10:625–629

    PubMed  Google Scholar 

  • Thavaneswaran P, Rudkin GE, Cooter RD, Moyes DG, Perera CL, Maddern GJ (2010) Brief reports: paravertebral block for anesthesia: a systematic review. Anesth Analg 110:1740–1744

    PubMed  Google Scholar 

  • Toda A, Watanabe G, Matsumoto I, Tomita S, Yamaguchi S, Ohtake H (2013) Monitoring brain oxygen saturation during awake off-pump coronary artery bypass. Asian Cardiovasc Thorac Ann 21:14–21

    PubMed  Google Scholar 

  • Torigoe K, Nakahara K, Rahmadi M, Yoshizawa K, Horiuchi H, Hirayama S, Imai S, Kuzumaki N, Itoh T, Yamashita A, Shakunaga K, Yamasaki M, Nagase H, Matoba M, Suzuki T, Narita M (2012) Usefulness of olanzapine as an adjunct to opioid treatment and for the treatment of neuropathic pain. Anesthesiology 116:159–169

    PubMed  CAS  Google Scholar 

  • Tsai HE, Liu LF, Dusting GJ, Weng WT, Chen SC, Kung ML, Tee R, Liu GS, Tai MH (2012) Pro-opiomelanocortin gene delivery suppresses the growth of established Lewis lung carcinoma through a melanocortin-1 receptor-independent pathway. J Gene Med 14:44–53

    PubMed  CAS  Google Scholar 

  • Tzortzopoulou A, McNicol ED, Cepeda MS, Francia MB, Farhat T, Schumann R (2011) Single dose intravenous propacetamol or intravenous paracetamol for postoperative pain. Cochrane Database Syst Rev:CD007126

    Google Scholar 

  • Ucak A, Onan B, Sen H, Selcuk I, Turan A, Yilmaz AT (2011) The effects of gabapentin on acute and chronic postoperative pain after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth 25:824–829

    PubMed  CAS  Google Scholar 

  • Urell C, Westerdahl E, Hedenstrom H, Janson C, Emtner M (2012) Lung function before and two days after open-heart surgery. Crit Care Res Pract 2012:291628

    PubMed  Google Scholar 

  • Usichenko TI, Rottenbacher I, Kohlmann T, Julich A, Lange J, Mustea A, Engel G, Wendt M (2013) Implementation of the quality management system improves postoperative pain treatment: a prospective pre-/post-interventional questionnaire study. Br J Anaesth 110(1):87–95

    PubMed  CAS  Google Scholar 

  • Vadivelu N, Mitra S, Hines RL (2011) Peripheral opioid receptor agonists for analgesia: a comprehensive review. J Opioid Manag 7:55–68

    PubMed  Google Scholar 

  • Valdez-Morales E, Guerrero-Alba R, Ochoa-Cortes F, Benson J, Spreadbury I, Hurlbut D, Miranda-Morales M, Lomax AE, Vanner S (2013) Release of endogenous opioids during a chronic IBD model suppresses the excitability of colonic DRG neurons. Neurogastroenterol Motil 25(1):39–46

    PubMed  CAS  Google Scholar 

  • van Gulik L, Janssen LI, Ahlers SJ, Bruins P, Driessen AH, van Boven WJ, van Dongen EP, Knibbe CA (2011) Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg 40:1309–1313

    PubMed  Google Scholar 

  • van Ojik AL, Jansen PA, Brouwers JR, van Roon EN (2012) Treatment of chronic pain in older people: evidence-based choice of strong-acting opioids. Drugs Aging 29:615–625

    PubMed  Google Scholar 

  • Visser LE, Graatsma HH, Stricker BH (2002) Contraindicated NSAIDs are frequently prescribed to elderly patients with peptic ulcer disease. Br J Clin Pharmacol 53:183–188

    PubMed  Google Scholar 

  • Waldhoer M, Bartlett SE, Whistler JL (2004) Opioid receptors. Annu Rev Biochem 73:953–990

    PubMed  CAS  Google Scholar 

  • Walker SM, Yaksh TL (2012) Review article: neuraxial analgesia in neonates and infants: a review of clinical and preclinical strategies for the development of safety and efficacy data. Anesth Analg 115:638–662

    PubMed  CAS  Google Scholar 

  • Watanabe G, Tomita S, Yamaguchi S, Yashiki N (2011) Awake coronary artery bypass grafting under thoracic epidural anesthesia: great impact on off-pump coronary revascularization and fast-track recovery. Eur J Cardiothorac Surg 40:788–793

    PubMed  Google Scholar 

  • White PF (2008) Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs 9:76–82

    PubMed  CAS  Google Scholar 

  • White JM, Irvine RJ (1999) Mechanisms of fatal opioid overdose. Addiction 94:961–972

    PubMed  CAS  Google Scholar 

  • White PF, Rawal S, Latham P, Markowitz S, Issioui T, Chi L, Dellaria S, Shi C, Morse L, Ing C (2003) Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 99:918–923

    PubMed  CAS  Google Scholar 

  • Wipke-Tevis DD, Stotts NA (1998) Effect of dressings on saphenous vein harvest incision pain, distress and cosmetic result. Prog Cardiovasc Nurs 13:3–13

    PubMed  CAS  Google Scholar 

  • Wolf AR (2012a) Effects of regional analgesia on stress responses to pediatric surgery. Paediatr Anaesth 22:19–24

    PubMed  Google Scholar 

  • Wolf AR (2012b) Paediatric cardiac anaesthesia: balancing risk and outcome. Br J Anaesth 109:12–15

    PubMed  CAS  Google Scholar 

  • Wu SY, Dun SL, Wright MT, Chang JK, Dun NJ (1999) Endomorphin-like immunoreactivity in the rat dorsal horn and inhibition of substantia gelatinosa neurons in vitro. Neuroscience 89:317–321

    PubMed  CAS  Google Scholar 

  • Yamanaka T, Sadikot RT (2013) Opioid effect on lungs. Respirology 18(2):255–262

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology and Anesthesiology Research Center, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ali Dabbagh MD

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  1. Ali Dabbagh MD
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Correspondence to Ali Dabbagh MD .

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Editors and Affiliations

  1. Dept. Anesthesiol. & Anesthesiol. Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ali Dabbagh

  2. Heart Transplant and Mechanical Circulatory Support, Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Fardad Esmailian

  3. Divisions of Cardiac Surgery, Brigham and Womens Hospital, Boston, Massachusetts, USA

    Sary F. Aranki

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© 2014 Springer-Verlag Berlin Heidelberg

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Dabbagh, A. (2014). Postoperative Pain Management in Cardiac Surgery. In: Dabbagh, A., Esmailian, F., Aranki, S. (eds) Postoperative Critical Care for Cardiac Surgical Patients. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40418-4_11

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  • DOI: https://doi.org/10.1007/978-3-642-40418-4_11

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  • Online ISBN: 978-3-642-40418-4

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