title: Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial.
abstract: BACKGROUND
  To evaluate if an opiate sparing multimodal regimen of dexamethasone, gabapentin, ibuprofen and paracetamol had better analgesic effect, less side effects and was safe compared to a traditional morphine and paracetamol regimen after cardiac surgery.
  
  
  METHODS
  Open-label, prospective randomized controlled trial. 180 patients undergoing cardiac procedures through median sternotomy, were included in the period march 2007-August 2009. 151 patients were available for analysis. Pain was assessed with the 11-numeric rating scale (11-NRS).
  
  
  RESULTS
  Patients in the multimodal group demonstrated significantly lower average pain scores from the day of surgery throughout the third postoperative day. Extensive nausea and vomiting, was found in no patient in the multimodal group but in 13 patients in the morphine group, p < 0.001. Postoperative rise in individual creatinine levels demonstrated a non-significant rise in the multimodal group, 33.0±53.4 vs. 19.9±48.5, p = 0.133. Patients in the multimodal group suffered less major in-hospital events in crude numbers: myocardial infarction (MI) (1 vs. 2, p = 0.54), stroke (0 vs. 3, p = 0.075), dialysis (1 vs. 2, p = 0.54), and gastrointestinal (GI) bleeding (0 vs. 1, p = 0.31). 30-day mortality was 1 vs. 2, p = 0.54.
  
  
  CONCLUSIONS
  In patients undergoing cardiac surgery, a multimodal regimen offered significantly better analgesia than a traditional opiate regimen. Nausea and vomiting complaints were significantly reduced. No safety issues were observed with the multimodal regimen.
  
  
  BACKGROUND
  Clinicaltrials.gov identifier: NCT01966172.
authors.affiliation: Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen O 2100, Denmark. sulman_raf@hotmail.com.
authors.forename: Sulman
authors.initials: S
authors.lastname: Rafiq
authors.forename: Daniel Andreas
authors.initials: DA
authors.lastname: Steinbrüchel
authors.forename: Michael Jaeger
authors.initials: MJ
authors.lastname: Wanscher
authors.forename: Lars Willy
authors.initials: LW
authors.lastname: Andersen
authors.forename: Albert
authors.initials: A
authors.lastname: Navne
authors.forename: Nikolaj Bang
authors.initials: NB
authors.lastname: Lilleoer
authors.forename: Peter Skov
authors.initials: PS
authors.lastname: Olsen
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007052:Ibuprofen / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003907:Dexamethasone; D007052:Ibuprofen