From the Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Münster, Münster, Germany (TM, EP-Z), the Department of Cardiovascular Sciences, Section Anaesthesiology, KU Leuven and University Hospital Leuven, Leuven, Belgium (NK, MVdeV, JK), the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Centre, Dallas, Texas, USA (GPJ).
Eur J Anaesthesiol. 2023 Oct 1;40(10):758-768. doi: 10.1097/EJA.0000000000001881. Epub 2023 Jul 19.
Pain after cardiac surgery via median sternotomy can be difficult to treat, and if inadequately managed can lead to respiratory complications, prolonged hospital stays and chronic pain.
To evaluate available literature and develop recommendations for optimal pain management after cardiac surgery via median sternotomy.
A systematic review using PROcedure-SPECific Pain Management (PROSPECT) methodology.
Randomised controlled trials and systematic reviews published in the English language until November 2020 assessing postoperative pain after cardiac surgery via median sternotomy using analgesic, anaesthetic or surgical interventions.
PubMed, Embase and Cochrane Databases.
Of 319 eligible studies, 209 randomised controlled trials and three systematic reviews were included in the final analysis. Pre-operative, intra-operative and postoperative interventions that reduced postoperative pain included paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), intravenous magnesium, intravenous dexmedetomidine and parasternal block/infiltration.
The analgesic regimen for cardiac surgery via sternotomy should include paracetamol and NSAIDs, unless contraindicated, administered intra-operatively and continued postoperatively. Intra-operative magnesium and dexmedetomidine infusions may be considered as adjuncts particularly when basic analgesics are not administered. It is not clear if combining dexmedetomidine and magnesium would provide superior pain relief compared with either drug alone. Parasternal block/surgical site infiltration is also recommended. However, no basic analgesics were used in the studies assessing these interventions. Opioids should be reserved for rescue analgesia. Other interventions, including cyclo-oxygenase-2 specific inhibitors, are not recommended because there was insufficient, inconsistent or no evidence to support their use and/or due to safety concerns.
经胸骨正中切开的心脏手术后疼痛可能难以治疗，如果处理不当，可能导致呼吸并发症、住院时间延长和慢性疼痛。
评估现有文献并为经胸骨正中切开的心脏手术后的最佳疼痛管理提出建议。
使用特定于程序的疼痛管理（PROSPECT）方法进行系统评价。
评估经胸骨正中切开的心脏手术后使用镇痛、麻醉或手术干预的术后疼痛的随机对照试验和系统评价，发表于 2020 年 11 月前的英文文献。
PubMed、Embase 和 Cochrane 数据库。
在 319 项合格研究中，209 项随机对照试验和 3 项系统评价纳入最终分析。可减少术后疼痛的术前、术中及术后干预措施包括对乙酰氨基酚、非甾体类抗炎药（NSAIDs）、静脉注射镁、静脉注射右美托咪定及胸骨旁阻滞/浸润。
胸骨切开术心脏手术的镇痛方案应包括对乙酰氨基酚和 NSAIDs，除非禁忌，术中给予并持续术后给予。术中镁和右美托咪定输注可作为辅助治疗，特别是在未给予基本镇痛药时。与单独使用任何一种药物相比，联合使用右美托咪定和镁是否能提供更好的镇痛效果尚不清楚。也推荐胸骨旁阻滞/手术部位浸润。然而，评估这些干预措施的研究中并未使用基本镇痛药。阿片类药物应留作解救性镇痛。其他干预措施，包括环氧化酶-2 特异性抑制剂，不建议使用，因为缺乏、不一致或没有证据支持其使用和/或由于安全性问题。
