Strumia Alessandro, Lusini Mario, Costa Fabio, Stefani Elisabetta, Cipollone Elena, Cusimano Livio, Libri Francesca, Ricci Massimiliano, Ruggiero Alessandro, Sarubbi Domenico, Mattei Alessia, Schiavoni Lorenzo, Barbato Raffaele, Mastroianni Ciro, Jawabra Mohamad, Agrò Felice Eugenio, Chello Massimo, Cataldo Rita, Carassiti Massimiliano, Pascarella Giuseppe
Operative Research Unit of Anesthesia and Intensive Care, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Research Unit of Cardiac Surgery, Department of Cardiovascular Surgery, University Campus Bio-Medico di Roma, Roma, Italy.
Pain Manag. 2025 Jul 10:1-15. doi: 10.1080/17581869.2025.2532359.
Pain management in cardiac surgery remains a critical component of perioperative care, influencing recovery, patient satisfaction, and outcomes. Traditional opioid-based analgesia is associated with significant adverse effects, prompting the exploration of multimodal strategies, including regional anesthesia (RA), non-opioid analgesics, and enhanced recovery after surgery (ERAS) protocols.This review evaluates the evolution of cardiac surgery pain management, from conventional opioid-based regimens to multimodal approaches with regional anesthesia.
A comprehensive analysis of existing literature was conducted, assessing the efficacy, safety, and integration of different pain management strategies in cardiac surgery on PubMed, Google Scholar, MEDLINE, UpToDate, Embase and Web of Science until 1 November 2024. Studies on opioids, adjunct analgesics (e.g. NSAIDs, acetaminophen, ketamine, dexmedetomidine), RA techniques, and ERAS frameworks were reviewed to provide a comparative perspective.
Multimodal analgesia significantly reduces opioid consumption, enhances pain control, and minimizes complications such as respiratory depression and postoperative nausea. RA techniques, including fascial plane blocks, offer promising opioid-sparing benefits. ERAS protocols further optimize recovery, yet challenges remain in standardizing approaches across institutions.
The future of cardiac surgery pain management lies in individualized, multimodal strategies following ERAS principles. Standardized guidelines and further research are needed to refine these protocols for widespread adoption.
心脏手术中的疼痛管理仍然是围手术期护理的关键组成部分，影响着恢复情况、患者满意度和手术结果。传统的基于阿片类药物的镇痛方法会产生显著的不良反应，这促使人们探索多模式镇痛策略，包括区域麻醉（RA）、非阿片类镇痛药以及术后加速康复（ERAS）方案。本综述评估了心脏手术疼痛管理从传统的基于阿片类药物的方案到采用区域麻醉的多模式方法的演变过程。
对现有文献进行了全面分析，在PubMed、谷歌学术、MEDLINE、UpToDate、Embase和科学网等数据库中评估不同疼痛管理策略在心脏手术中的疗效、安全性和整合情况，检索截至2024年11月1日的相关研究。对阿片类药物、辅助镇痛药（如非甾体抗炎药、对乙酰氨基酚、氯胺酮、右美托咪定）、区域麻醉技术和ERAS框架的研究进行了综述，以提供比较视角。
多模式镇痛显著减少了阿片类药物的用量，增强了疼痛控制，并将呼吸抑制和术后恶心等并发症降至最低。包括筋膜平面阻滞在内的区域麻醉技术具有显著的阿片类药物节省效益。ERAS方案进一步优化了恢复过程，但在各机构之间标准化方法方面仍存在挑战。
心脏手术疼痛管理的未来在于遵循ERAS原则的个体化多模式策略。需要标准化指南和进一步研究来完善这些方案，以便广泛应用。
