title: Five-day pain management regimen using patient-controlled analgesia facilitates early ambulation after cardiac surgery.
abstract: OBJECTIVE
  Excessive pain may interrupt early rehabilitation after cardiac surgery. The purpose of this study was to evaluate the efficacy of a longer patient-controlled analgesia (PCA) regimen for early ambulation after cardiac surgery.
  
  
  METHODS
  This study was designed to be a retrospective, single-institutional (focusing on an urban, university-affiliated hospital), pre-post intervention survey. Fifty-nine patients undergoing elective cardiac surgery were included. A long pain management regimen (subcutaneous fentanyl PCA for up to 120 h) protocol was implemented for the postoperative care for adult cardiac surgery patients. Before implementing this extended protocol, the same PCA regimen was used for up to 40 h. Perioperative and postoperative management was similar for all patients. The number of days required to walk more than 100 m without assistance was recorded. Additional usage of analgesic drugs and pain intensity on movement were documented up to POD 5.
  
  
  RESULTS
  Time required to walk more than 100 m without assistance was significantly shorter in the 120 h PCA group. Need for another analgesic regimen and pain score during the ambulation phase were significantly lower in the 120 h PCA than in the 40 h PCA group. Frequency of side effects was similar for both groups.
  
  
  CONCLUSIONS
  Pain management using a PCA system can be recommended for patients during the ambulation period after cardiac surgery. Subcutaneous PCA with fentanyl is a safe and effective analgesic regimen for this purpose.
authors.affiliation: Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Izumi
authors.forename: Fumimasa
authors.initials: F
authors.lastname: Amaya
authors.forename: Koji
authors.initials: K
authors.lastname: Hosokawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ueno
authors.forename: Toyoshi
authors.initials: T
authors.lastname: Hosokawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000534:rehabilitation*; D004434:Early Ambulation; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl