title: Assessment of feasibility and efficacy of Class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: A pilot study.
abstract: BACKGROUND
  Laser therapy, for its established analgesic properties with minimal side effects, has been used for the treatment of chronic pain. However, it has not been used for the treatment of acute postoperative pain. This pilot study was designed to assess the feasibility and efficacy of Class IV laser on postoperative pain relief following off-pump coronary artery bypass graft (OPCABG) surgery, as a component of multimodal analgesia (MMA) technique.
  
  
  METHODS
  This open observational prospective study comprised of 100 adult patients (84 male, 16 female) who underwent OPCABG through sternotomy. For postoperative analgesia, they were subjected to laser therapy subjected to laser therapy in addition to the standard institutional pain management protocol comprising of IV infusion/bolus of tramadol and paracetamol and fentanyl bolus as rescue analgesic. Pain intensity was measured by Verbal Rating Scale (VRS). The laser therapy was scheduled as once a day regime for three consecutive postoperative days (PODs) starting on POD 1, 30 min following tracheal extubation. The subsequent laser applications were also scheduled at the same time of the day as on day 1 if VRS was ≥5. 10 W Class IV laser was applied over 150 cm² sternal wound area for 150 s. VRS was used to assess pain severity and was recorded for statistical analysis using Friedman Test.
  
  
  RESULTS
  The mean (standard deviation [SD]) VRS of all the 100 patients just before application of the first dose of laser was 7.31 (0.94) while on MMT; the same fell to 4.0 (1.279) and 3.40 (2.697) at 1 h and 24 h respectively following first dose of laser. The change of VRS over first 24 h among all the 100 patients was statistically significant (P = 0.000). Laser was re-applied in 40 patients whose VRS was ≥5 (mean [SD] - 6.38 [0.868]) at 24th h. After receiving the 2nd dose of laser the VRS scores fell significantly (P = 0.000) and became 0 at 54th h. No patients required 3rd dose of the laser. No patient required rescue analgesic while on laser therapy.
  
  
  CONCLUSIONS
  Class IV laser can be an effective technique for postoperative analgesia following OPCABG surgery through sternotomy when included as a component of MMA technique.
authors.affiliation: Department of Anaesthesiology and Critical Care, Fortis Escorts Heart Institute, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Karlekar
authors.forename: Saswata
authors.initials: S
authors.lastname: Bharati
authors.forename: Ravindra
authors.initials: R
authors.lastname: Saxena
authors.forename: Kanchan
authors.initials: K
authors.lastname: Mehta
mesh_terms: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D003131:Combined Modality Therapy; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D028022:Low-Level Light Therapy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid