• Yuta Izumi, Fumimasa Amaya, Koji Hosokawa, Hiroshi Ueno, Toyoshi Hosokawa, Satoru Hashimoto, and Yoshifumi Tanaka.
• Department of Anesthesiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
• J Anesth. 2010 Apr 1;24(2):187-91.

PurposeExcessive pain may interrupt early rehabilitation after cardiac surgery. The purpose of this study was to evaluate the efficacy of a longer patient-controlled analgesia (PCA) regimen for early ambulation after cardiac surgery.MethodsThis study was designed to be a retrospective, single-institutional (focusing on an urban, university-affiliated hospital), pre-post intervention survey. Fifty-nine patients undergoing elective cardiac surgery were included. A long pain management regimen (subcutaneous fentanyl PCA for up to 120 h) protocol was implemented for the postoperative care for adult cardiac surgery patients. Before implementing this extended protocol, the same PCA regimen was used for up to 40 h. Perioperative and postoperative management was similar for all patients. The number of days required to walk more than 100 m without assistance was recorded. Additional usage of analgesic drugs and pain intensity on movement were documented up to POD 5.ResultsTime required to walk more than 100 m without assistance was significantly shorter in the 120 h PCA group. Need for another analgesic regimen and pain score during the ambulation phase were significantly lower in the 120 h PCA than in the 40 h PCA group. Frequency of side effects was similar for both groups.ConclusionPain management using a PCA system can be recommended for patients during the ambulation period after cardiac surgery. Subcutaneous PCA with fentanyl is a safe and effective analgesic regimen for this purpose.

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