Background Inadequate pain control after coronary artery bypass grafting (CABG) impedes recovery. While Enhanced Recovery After Surgery (ERAS) protocols advocate opioid-sparing multimodal analgesia (MMA), standardized protocols may not address individual pain trajectories. This study evaluated whether an early, goal-directed multimodal analgesia (GDMA) strategy improves postoperative outcomes compared to conventional analgesia. Methods This single-center retrospective cohort study included adults undergoing elective, isolated CABG (2019–2023). Patients were stratified into GDMA (analgesia titrated to predefined functional pain targets using ≥ 3 analgesic classes) or Traditional Analgesia (TA; opioid-centric, reactive) groups based on documented regimens. Primary outcomes were 48-hour opioid consumption (morphine milligram equivalents, MME) and pain scores (Numerical Rating Scale, NRS). Secondary outcomes included recovery milestones (mechanical ventilation duration, ICU/hospital length of stay) and complications. Propensity score matching (1:1) generated balanced cohorts (n = 210 per group). Multivariable regression adjusted for confounders. Results After matching, the GDMA group demonstrated significantly lower 48-hour opioid consumption (median MME: 48.5 vs. 75.0 mg; p < 0.001) and superior dynamic pain control during activity (significant group-by-time interaction, p = 0.003), despite comparable resting pain scores. The GDMA strategy was associated with accelerated recovery: shorter duration of mechanical ventilation (7.0 vs. 9.0 h, p < 0.001), time to first ambulation (22.5 vs. 32.0 h, p < 0.001), ICU stay (22.0 vs. 45.0 h, p < 0.001), and postoperative hospital stay (7.0 vs. 8.0 days, p < 0.001). Complication rates were significantly lower for GDMA regarding postoperative delirium (4.8% vs. 11.9%, p = 0.008), pulmonary infection (3.3% vs. 8.6%, p = 0.018), and nausea/vomiting (10.0% vs. 19.0%, p = 0.007). Multivariable analysis confirmed GDMA as an independent protective factor against prolonged hospital stay (aOR: 0.48) and delirium (aOR: 0.37). Conclusion An early GDMA strategy after CABG significantly reduces opioid consumption, provides superior dynamic pain control, accelerates recovery, and decreases key complications. These findings suggest that an early GDMA strategy may represent a promising and safe paradigm within ERAS cardiac pathways.

Goal-directed multimodal analgesia to enhance recovery after coronary artery bypass grafting: a retrospective cohort study

期刊论文
出版模式：

开放获取
发表日期：

2026年4月13日

查看全文

MingShan Lin,
HuBin Piao,
JingWei Liu

摘要

Background

Inadequate pain control after coronary artery bypass grafting (CABG) impedes recovery. While Enhanced Recovery After Surgery (ERAS) protocols advocate opioid-sparing multimodal analgesia (MMA), standardized protocols may not address individual pain trajectories. This study evaluated whether an early, goal-directed multimodal analgesia (GDMA) strategy improves postoperative outcomes compared to conventional analgesia.

Methods

This single-center retrospective cohort study included adults undergoing elective, isolated CABG (2019–2023). Patients were stratified into GDMA (analgesia titrated to predefined functional pain targets using ≥ 3 analgesic classes) or Traditional Analgesia (TA; opioid-centric, reactive) groups based on documented regimens. Primary outcomes were 48-hour opioid consumption (morphine milligram equivalents, MME) and pain scores (Numerical Rating Scale, NRS). Secondary outcomes included recovery milestones (mechanical ventilation duration, ICU/hospital length of stay) and complications. Propensity score matching (1:1) generated balanced cohorts (n = 210 per group). Multivariable regression adjusted for confounders.

Results

After matching, the GDMA group demonstrated significantly lower 48-hour opioid consumption (median MME: 48.5 vs. 75.0 mg; p < 0.001) and superior dynamic pain control during activity (significant group-by-time interaction, p = 0.003), despite comparable resting pain scores. The GDMA strategy was associated with accelerated recovery: shorter duration of mechanical ventilation (7.0 vs. 9.0 h, p < 0.001), time to first ambulation (22.5 vs. 32.0 h, p < 0.001), ICU stay (22.0 vs. 45.0 h, p < 0.001), and postoperative hospital stay (7.0 vs. 8.0 days, p < 0.001). Complication rates were significantly lower for GDMA regarding postoperative delirium (4.8% vs. 11.9%, p = 0.008), pulmonary infection (3.3% vs. 8.6%, p = 0.018), and nausea/vomiting (10.0% vs. 19.0%, p = 0.007). Multivariable analysis confirmed GDMA as an independent protective factor against prolonged hospital stay (aOR: 0.48) and delirium (aOR: 0.37).

Conclusion

An early GDMA strategy after CABG significantly reduces opioid consumption, provides superior dynamic pain control, accelerates recovery, and decreases key complications. These findings suggest that an early GDMA strategy may represent a promising and safe paradigm within ERAS cardiac pathways.