title: Novel approaches in pain management in cardiac surgery.
abstract: OBJECTIVE
  Open cardiac surgery may cause severe postoperative pain and the activation of a perioperative stress response. If not treated adequately, the patient may suffer increased morbidity, a longer hospital stay, and higher overall costs. This article reviews the literature regarding various modalities for management of postoperative pain after cardiac surgery.
  
  
  RESULTS
  Paravertebral block of the spinal nerve roots provides similar analgesia to thoracic epidural without the risk of hypotension or epidural hematoma. Continuous α-2 agonist infusion reduces opioid requirements in the immediate postoperative period and may convey a morbidity and mortality benefit in cardiac surgery patients that persists for 12 months. Antiepileptics may significantly decrease opioid requirements and improve pain scores. Finally, complementary and alternative practices such as acupuncture, music, and behavioral exercises both pre and postoperatively may improve acute pain and lessen conversion to chronic pain.
  
  
  CONCLUSIONS
  Although published data remain limited, recent evidence indicates that patients may benefit from the addition of a variety of novel pain-management strategies currently under investigation. Selection of a multimodal approach to perioperative pain management is advocated, including selective application of regional analgesia, non-narcotic medications, and complimentary alternative options to improve patient comfort and overall outcome.
authors.affiliation: Department of Anesthesiology and Critical Care, University of Maryland School of Medicine, Baltimore, Maryland, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Bigeleisen
authors.forename: Nicholas
authors.initials: N
authors.lastname: Goehner
mesh_terms: D000698:Analgesia / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D019990:Perioperative Care / Q000379:methods*