Improved postoperative pain relief via preemptive analgesia in relation to heart rate variability for coronary artery bypass grafting: A preliminary report

Ming Chi Yung, Yen Chang, Shiau Ting Lai, Mei Yung Tsou, Kwok Han Chan

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background. Sudden cardiac death remains to be the most devastating outcome for patients who undergo cardiac surgery. Surgical stress in combination with postoperative pain are key factors of such tragedy. Preemptive analgesia (PA) is supposed to provide optimal postoperative pain management, and epidural morphine infusion to provide effective pain relief and stress reduction after cardiac surgery. Heart rate (HR) variability seems to correlate to the survival of acute myocardial infarction (AMI) patients. This study was conducted to evaluate the benefits of PA for coronary artery bypass grafting (CABG) patients in the sense of improvement in postoperative respiratory and cardiovascular functions, and its correlation to HR and HR variability. Methods. A total of 40 patients who underwent CABG from June 1995 to December 1995 were randomly selected and divided into two groups (Group A and Group B). Group A (n=20) was treated with conventional postoperative analgesia of intravenous (IV) meperidine HCl (Demerol). Group B (n=20) was treated with PA using epidural infusion of local anesthetics plus ketamine and morphine during surgery and then using intermittent epidural morphine infusion for postoperative pain control when necessary, and Demerol was given intravenously as in group A. Postoperative pain intensity was measured by a modified visual analogue pain scale from 0 to 10 (0=no pain, 10=severe pain). Perioperative HR and HR variability data based on 24-hour electrocardiograph (ECG) Holter monitoring along with data on respiratory and cardiovascular functions were gathered, analyzed, and compared between Group A and Group B. Results. Effective analgesia (mean pain score of 0-2) was achieved in 50% of Group A patients and 75% of Group B patients. Group B with the reduced dosage of demerol also had the benefits of smaller degree of respiratory insufficiency, earlier extubation, and less incidence of reintubation as compared with Group A. For HR comparison between Group A and Group B, statistically significant differences (p<0.05) were observed in 3 out of the 16 postoperative time segments. For HR variability comparison between Group A and Group B, statistically significant difference (p<0.05) was observed in one of the time segments while another segment showed marginal significance (p=0.061). Group B patients also maintained better overall respiratory and cardiovascular functions. Conclusions. PA method through the use of epidural anesthesia along with morphine infusion provided better postoperative pain relief and more stable respiratory and cardiovascular functions in our patients with cardiac surgery. Although the differences in HR and HR variability between the control and the PA groups were not statistically significant throughout the period studied, the potential benefits of better understanding the relationship between postoperative pain control and HR variability justify further studies to be conducted.

Original languageEnglish
Pages (from-to)28-35
Number of pages8
JournalChinese Medical Journal (Taipei)
Volume60
Issue number1
Publication statusPublished - Oct 1 1997
Externally publishedYes

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Postoperative Pain
Coronary Artery Bypass
Analgesia
Heart Rate
Meperidine
Morphine
Thoracic Surgery
Pain
Ambulatory Electrocardiography
Epidural Analgesia
Epidural Anesthesia
Sudden Cardiac Death
Ketamine
Pain Measurement
Pain Management
Local Anesthetics
Respiratory Insufficiency
Electrocardiography
Myocardial Infarction
Survival

Keywords

  • Coronary artery bypass grafting
  • Epidural anesthesia
  • Heart rate variability
  • Holter ECG monitor
  • Preemptive analgesia

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Improved postoperative pain relief via preemptive analgesia in relation to heart rate variability for coronary artery bypass grafting : A preliminary report. / Yung, Ming Chi; Chang, Yen; Lai, Shiau Ting; Tsou, Mei Yung; Chan, Kwok Han.

In: Chinese Medical Journal (Taipei), Vol. 60, No. 1, 01.10.1997, p. 28-35.

Research output: Contribution to journalArticle

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abstract = "Background. Sudden cardiac death remains to be the most devastating outcome for patients who undergo cardiac surgery. Surgical stress in combination with postoperative pain are key factors of such tragedy. Preemptive analgesia (PA) is supposed to provide optimal postoperative pain management, and epidural morphine infusion to provide effective pain relief and stress reduction after cardiac surgery. Heart rate (HR) variability seems to correlate to the survival of acute myocardial infarction (AMI) patients. This study was conducted to evaluate the benefits of PA for coronary artery bypass grafting (CABG) patients in the sense of improvement in postoperative respiratory and cardiovascular functions, and its correlation to HR and HR variability. Methods. A total of 40 patients who underwent CABG from June 1995 to December 1995 were randomly selected and divided into two groups (Group A and Group B). Group A (n=20) was treated with conventional postoperative analgesia of intravenous (IV) meperidine HCl (Demerol). Group B (n=20) was treated with PA using epidural infusion of local anesthetics plus ketamine and morphine during surgery and then using intermittent epidural morphine infusion for postoperative pain control when necessary, and Demerol was given intravenously as in group A. Postoperative pain intensity was measured by a modified visual analogue pain scale from 0 to 10 (0=no pain, 10=severe pain). Perioperative HR and HR variability data based on 24-hour electrocardiograph (ECG) Holter monitoring along with data on respiratory and cardiovascular functions were gathered, analyzed, and compared between Group A and Group B. Results. Effective analgesia (mean pain score of 0-2) was achieved in 50{\%} of Group A patients and 75{\%} of Group B patients. Group B with the reduced dosage of demerol also had the benefits of smaller degree of respiratory insufficiency, earlier extubation, and less incidence of reintubation as compared with Group A. For HR comparison between Group A and Group B, statistically significant differences (p<0.05) were observed in 3 out of the 16 postoperative time segments. For HR variability comparison between Group A and Group B, statistically significant difference (p<0.05) was observed in one of the time segments while another segment showed marginal significance (p=0.061). Group B patients also maintained better overall respiratory and cardiovascular functions. Conclusions. PA method through the use of epidural anesthesia along with morphine infusion provided better postoperative pain relief and more stable respiratory and cardiovascular functions in our patients with cardiac surgery. Although the differences in HR and HR variability between the control and the PA groups were not statistically significant throughout the period studied, the potential benefits of better understanding the relationship between postoperative pain control and HR variability justify further studies to be conducted.",
keywords = "Coronary artery bypass grafting, Epidural anesthesia, Heart rate variability, Holter ECG monitor, Preemptive analgesia",
author = "Yung, {Ming Chi} and Yen Chang and Lai, {Shiau Ting} and Tsou, {Mei Yung} and Chan, {Kwok Han}",
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T1 - Improved postoperative pain relief via preemptive analgesia in relation to heart rate variability for coronary artery bypass grafting

T2 - A preliminary report

AU - Yung, Ming Chi

AU - Chang, Yen

AU - Lai, Shiau Ting

AU - Tsou, Mei Yung

AU - Chan, Kwok Han

PY - 1997/10/1

Y1 - 1997/10/1

N2 - Background. Sudden cardiac death remains to be the most devastating outcome for patients who undergo cardiac surgery. Surgical stress in combination with postoperative pain are key factors of such tragedy. Preemptive analgesia (PA) is supposed to provide optimal postoperative pain management, and epidural morphine infusion to provide effective pain relief and stress reduction after cardiac surgery. Heart rate (HR) variability seems to correlate to the survival of acute myocardial infarction (AMI) patients. This study was conducted to evaluate the benefits of PA for coronary artery bypass grafting (CABG) patients in the sense of improvement in postoperative respiratory and cardiovascular functions, and its correlation to HR and HR variability. Methods. A total of 40 patients who underwent CABG from June 1995 to December 1995 were randomly selected and divided into two groups (Group A and Group B). Group A (n=20) was treated with conventional postoperative analgesia of intravenous (IV) meperidine HCl (Demerol). Group B (n=20) was treated with PA using epidural infusion of local anesthetics plus ketamine and morphine during surgery and then using intermittent epidural morphine infusion for postoperative pain control when necessary, and Demerol was given intravenously as in group A. Postoperative pain intensity was measured by a modified visual analogue pain scale from 0 to 10 (0=no pain, 10=severe pain). Perioperative HR and HR variability data based on 24-hour electrocardiograph (ECG) Holter monitoring along with data on respiratory and cardiovascular functions were gathered, analyzed, and compared between Group A and Group B. Results. Effective analgesia (mean pain score of 0-2) was achieved in 50% of Group A patients and 75% of Group B patients. Group B with the reduced dosage of demerol also had the benefits of smaller degree of respiratory insufficiency, earlier extubation, and less incidence of reintubation as compared with Group A. For HR comparison between Group A and Group B, statistically significant differences (p<0.05) were observed in 3 out of the 16 postoperative time segments. For HR variability comparison between Group A and Group B, statistically significant difference (p<0.05) was observed in one of the time segments while another segment showed marginal significance (p=0.061). Group B patients also maintained better overall respiratory and cardiovascular functions. Conclusions. PA method through the use of epidural anesthesia along with morphine infusion provided better postoperative pain relief and more stable respiratory and cardiovascular functions in our patients with cardiac surgery. Although the differences in HR and HR variability between the control and the PA groups were not statistically significant throughout the period studied, the potential benefits of better understanding the relationship between postoperative pain control and HR variability justify further studies to be conducted.

AB - Background. Sudden cardiac death remains to be the most devastating outcome for patients who undergo cardiac surgery. Surgical stress in combination with postoperative pain are key factors of such tragedy. Preemptive analgesia (PA) is supposed to provide optimal postoperative pain management, and epidural morphine infusion to provide effective pain relief and stress reduction after cardiac surgery. Heart rate (HR) variability seems to correlate to the survival of acute myocardial infarction (AMI) patients. This study was conducted to evaluate the benefits of PA for coronary artery bypass grafting (CABG) patients in the sense of improvement in postoperative respiratory and cardiovascular functions, and its correlation to HR and HR variability. Methods. A total of 40 patients who underwent CABG from June 1995 to December 1995 were randomly selected and divided into two groups (Group A and Group B). Group A (n=20) was treated with conventional postoperative analgesia of intravenous (IV) meperidine HCl (Demerol). Group B (n=20) was treated with PA using epidural infusion of local anesthetics plus ketamine and morphine during surgery and then using intermittent epidural morphine infusion for postoperative pain control when necessary, and Demerol was given intravenously as in group A. Postoperative pain intensity was measured by a modified visual analogue pain scale from 0 to 10 (0=no pain, 10=severe pain). Perioperative HR and HR variability data based on 24-hour electrocardiograph (ECG) Holter monitoring along with data on respiratory and cardiovascular functions were gathered, analyzed, and compared between Group A and Group B. Results. Effective analgesia (mean pain score of 0-2) was achieved in 50% of Group A patients and 75% of Group B patients. Group B with the reduced dosage of demerol also had the benefits of smaller degree of respiratory insufficiency, earlier extubation, and less incidence of reintubation as compared with Group A. For HR comparison between Group A and Group B, statistically significant differences (p<0.05) were observed in 3 out of the 16 postoperative time segments. For HR variability comparison between Group A and Group B, statistically significant difference (p<0.05) was observed in one of the time segments while another segment showed marginal significance (p=0.061). Group B patients also maintained better overall respiratory and cardiovascular functions. Conclusions. PA method through the use of epidural anesthesia along with morphine infusion provided better postoperative pain relief and more stable respiratory and cardiovascular functions in our patients with cardiac surgery. Although the differences in HR and HR variability between the control and the PA groups were not statistically significant throughout the period studied, the potential benefits of better understanding the relationship between postoperative pain control and HR variability justify further studies to be conducted.

KW - Coronary artery bypass grafting

KW - Epidural anesthesia

KW - Heart rate variability

KW - Holter ECG monitor

KW - Preemptive analgesia

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