Similar pain scores after early and late extubation in heart surgery with cardiopulmonary bypass.

OBJECTIVE

To investigate if early extubation, 2 hours after surgery, would result in more postoperative pain or in an increased use of opioid analgesics compared with late extubation, 6 hours after surgery.

DESIGN

Prospective, randomized study.

SETTING

Intensive care unit, university hospital.

PARTICIPANTS

Sixty patients undergoing cardiac surgery with cardiopulmonary bypass.

INTERVENTIONS

Patients were randomized into 2 groups: extubation at about 2 (early) or 6 (late) hours. Anesthesia was based on propofol and remifentanil. There was no epidural analgesia and no local anesthesia in the wound. A bolus of the opioid ketobemidone was administered toward the end of surgery followed by a continuous infusion.

MEASUREMENTS AND MAIN RESULTS

Pain, provoked during deep breathing or coughing, evaluated with a visual analog scale (VAS) going from 0 to 10, was measured after extubation, and at 8 and 16 hours after surgery. Unprovoked pain was measured hourly. If VAS was greater than 3, the infusion rate was increased and a bolus of ketobemidone was given. Three patients in the late group were excluded because of incomplete data. Pain did not differ between the early and late groups at any time. In all patients, 21 never scored >3, 11 scored >3 once, and 25 scored >3 more than once. Nine patients had 1 score >5. The amount of ketobemidone was similar in both groups.

CONCLUSIONS

Early extubation had no negative effect on the quality of postoperative pain control and was not followed by an increased use of analgesics.