Multimodal Analgesia

Created: June 28, 2021

Last Updated: November 18, 2023

Contributor(s):

Kathryn Deere PharmD BCPS

ERAS Cardiac Collaborative Network

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Alexander Gregory MD FRCPC

Summary

Multimodal analgesia after cardiac surgery is highly beneficial for enhancing pain control, reducing opioid consumption, and promoting faster recovery. It integrates various pharmacological and non-pharmacological methods to provide comprehensive and individualized postoperative pain management, leading to improved patient outcomes and satisfaction.

Multimodal analgesia involves combining various analgesic strategies manage pain more effectively after cardiac surgery. Each method targets a different pain pathway, resulting in enhanced pain relief without relying on high doses of a single type of medication, thereby reducing the risk of side effects and adverse event.

A comprehensive and effective approach to multimodal analgesia can lead to several potential benefits:

Enhanced Pain Control:

  • Effective Pain Management utilizing various drugs and techniques that work synergistically to provide superior pain relief.
  • Customization allows for tailored pain management strategies to meet individual patient needs and responses.

Reduced Opioid Consumption:

  • Lower doses decrease the reliance on opioids, thereby minimizing the risk of side effects or adverse events such as respiratory depression, nausea, constipation, sedation, or new persistent post-operative opioid use.

Faster Mobilization:

  • Effective pain control facilitates early ambulation, which is critical for rapid recovery.

Shorter Hospital Stay:

  • Improved analgesia and avoidance of side effects/adverse events may lead to decreased length of hospital stay.

Enhanced Patient Satisfaction:

  • Optimizing pain management while reducing side effects combine to increase patient comfort while improving their overall recovery experience and satisfaction.

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

ERAS Cardiac VTC Disclaimer:

The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

All the material presented on the VTC is the intellectual property of the ERAS Cardiac Society, its contributors, and its sponsors. Unless explicitly stated, the information, images, audio, video, and other content may not be reproduced (in whole or in part) in any way without the written permission of the ERAS Cardiac Society.

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Educational Materials

Multimodal Analgesia & Opioid Reduction
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss multimodal analgesia options and the importance of opioid reduction.
Multimodal Analgesia and Opioid Stewardship
Kathryn Deere, a pharmacist from the University of Maryland, provides the pharmacists perspective on multimodal analgesia strategies and opioid stewardship.
Regional Anesthesia in Cardiac Surgery
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss the various regional anesthesia techniques for cardiac surgery.
ERAS Controversies: Regional Anesthesia for Everyone?
This video is a recording of a previous ERAS Cardiac webinar held in conjunction with CTSNet. Please visit CTSNet [https://www.ctsnet.org] for additional educational content. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss controversies regarding regional anesthesia- should it be used for every patient or just select circumstances?
Alternative Multimodal Analgesia Options: Methadone and Sternal Fixation
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss some less common methods to provide opioid-sparing analgesia: methadone and rigid sternal fixation.

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