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Crit Care Nurs Clin North Am. 2019 Sep;31(3):389-405. doi: 10.1016/j.cnc.2019.05.007. Epub 2019 Jun 28.

Pain Control in the Cardiothoracic Surgery Patient.

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Adult-Gerontology Acute Care Nurse Practitioner Program, Georgetown University School of Nursing and Health Studies, 3700 Reservoir Road Northwest, Washington, DC 20057, USA; Wake Med Heart and Vascular Cardiothoracic Surgery, 3000 New Bern Avenue, Suite 1100, Raleigh, NC 27616, USA. Electronic address:


Opioid analgesics are the historical mainstay for postoperative cardiothoracic surgery pain relief. Although opioids are efficacious, they are linked with adverse effects, including sedation and respiratory depression. Emerging research is helping clinicians move toward evidence-based, opioid-sparing management strategies, including peripheral nerve blocks and multimodal analgesia. Good communication is essential to understanding patients' perceptions of pain and attitudes toward different pain-relief methods. Preoperatively educating patients and families on expected nociception and treatment options decreases postprocedural pain. Discussing use of nonopioid analgesics for mild pain and instructions on tapering opioid medications at discharge may prevent future misuse.


Enhanced recovery after surgery; Epidural analgesia; Ketamine; Liposomal bupivacaine; Multimodal pain control; Nonopioid adjuncts; Opioid analgesics; Postoperative pain management


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