Pain and Inflammatory Response following Off-Pump Coronary Artery Bypass Grafting

PURPOSE OF REVIEW:

Inflammation and pain are
two common clinical issues following cardiac surgery, which are
important to patient outcomes. This article reviews the literature
regarding inflammation and pain following cardiac surgery with special
emphasis on off-pump cardiac surgery.

RECENT FINDINGS:

Off-pump
surgery is associated with decreased intraoperative inflammatory
response compared with procedures using cardiopulmonary bypass; however,
the postoperative pattern of inflammatory response is similar to
on-pump procedures. Multimodal analgesic regimens and protocol-based
approaches to pain management improve analgesia compared to conventional
approaches.

SUMMARY:

Off-pump cardiac surgeries although
known to decrease the inflammatory burden do not appear to impact the
overall patient outcomes. Recent evidence indicates the prothrombotic
tendency following off-pump procedures, which could be related to the
time course of inflammation following off-pump cardiac surgery. There
might be some benefit of off-pump procedures regarding neurological and
renal function that needs further studies. Pain management following
off-pump procedures is similar to that of patients undergoing on-pump
cardiac surgery. Better caregiver and patient education is crucial for
improving pain control following cardiac surgery. Analgesic regimens
need to consider adjuvants and regional analgesic techniques and
patient-controlled modalities while providing care.