Single-Center Retrospective Comparison of Opioid-Based and Multimodal Analgesic Regimens in Adult Cardiac Surgery

Eisenbraun, A; Schroeder, D; Schaff, HV; Martin, E; Wittwer, ED

doi:10.1053/j.jvca.2023.03.001

Cardiothoracic & vascular anesthesia

Single-Center Retrospective Comparison of Opioid-Based and Multimodal Analgesic Regimens in Adult Cardiac Surgery

J Cardiothorac Vasc AnesthPublished 10 Mar 2023Retrospective cohort study

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Authors' conclusion

Multimodal analgesic regimens, particularly when incorporating methadone and dexmedetomidine, significantly reduced total and predischarge opioid use in cardiac surgical patients.

Study context

Population: Adult cardiac surgical patients, large tertiary-care facility

Exposure: Multimodal regimen 1 or 2 vs opioid-only regimen
Outcome: Intraoperative opioid use (oral morphine equivalents)
Follow-up: Intraoperative

Methodological details2-stage, single-centre

2-stage
Single-centre

Main finding

As reported in the abstract

Opioid-only425median · range (as printed) 314–518 · mg

Multimodal regimen 1150median · range (as printed) 75–150 · mg

Multimodal regimen 2230median · range (as printed) 160–240 · mg

P < 0.001

Observational data: associations, not effects.

Further findings

Predischarge opioid use (OME) — Multimodal regimens 1 and 2 vs Opioid-only

P < 0.001

Opioid-onlymedian 7.5 (range 0–22.5) mgas printed

Multimodal regimen 1median 5 (range 0–22.5) mgas printed

Multimodal regimen 2median 0 (range 0–15.0) mgas printed

Outcome	← Lower with multimodal regimen 2 ←→ Higher with multimodal regimen 2 →	Estimated difference (95% CI)	P value
Pain scores · Hours 0 to 6Multimodal regimen 2 vs Opioid-only	−2−101	−1.5 (−1.8 to −1.2)	P < 0.001
	−2−101Difference (linear scale)

Time to tracheal extubation

Opioid-only4.2 (range 2.8–6.0) hoursas printed

Multimodal regimen 13.6 (range 2.3–5.7) hoursas printed

Multimodal regimen 2—

— not stated in the abstract

Time to tracheal extubation: central value for multimodal regimen 2 not printed

Time to tracheal extubation

Clinically equivalent across all regimens

Safety

PONV treatment (postoperative antiemetic use)

Opioid-only64%

Multimodal regimen 153%

Multimodal regimen 262%

Postoperative nausea and vomiting (PONV) treatment (postoperative antiemetic use)

Reduced in multimodal regimen 1 vs opioid-based or multimodal regimen 2

Original publication

Single-Center Retrospective Comparison of Opioid-Based and Multimodal Analgesic Regimens in Adult Cardiac Surgery. J Cardiothorac Vasc Anesth. Published 10 March 2023. doi:10.1053/j.jvca.2023.03.001

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