Multimodal analgesia in cardiac surgery: Impact on postoperative medication consumption and cognitive function

BACKGROUND Patients who undergo cardiac surgery often face postoperative pain and potential cognitive issues. Multimodal analgesia may address these problems. We hypothesized that multimodal analgesia can reduce opioid use and improve cognitive recovery. AIM To investigate the effects of multimodal analgesia on postoperative opioid consumption and cognitive recovery in patients who underwent cardiac surgery. METHODS A prospective, randomized controlled trial at General Hospital from January 2020 to April 2023 recruited a total of 150 adult patients who underwent elective cardiac surgery. The patients were randomly divided into two groups. Group A had patient-controlled intravenous analgesia with sufentanil and flurbiprofen axil. Group B had flurbiprofen axil and paravertebral nerve block. Data were analyzed with appropriate statistical methods. RESULTS Group B had lower postoperative patient-controlled intravenous analgesia drug consumption (2.21 mL/hour vs 4.26 mL/hour, P < 0.001), shorter extubation time (2.32 hours vs 3.81 hours, P < 0.001), and intensive care unit stay (15.32 h vs 28.63 h, P < 0.001). Visual Analogue Scale pain scores were lower in group B (P < 0.001). Group B had fewer postoperative complications (no respiratory depression vs 37.9% in group A, P < 0.05), a lower postoperative cognitive dysfunction incidence (16.0% vs 28.0%, P < 0.05), and higher Barthel Index scores (P < 0.05). CONCLUSION Multimodal analgesia with paravertebral nerve block and flurbiprofen axil reduces opioid use and improves cognitive outcomes in patients who underwent cardiac surgery.