Assessment and Pathophysiology of Pain in Cardiac Surgery

Cardiac surgery pain is most severe during the first 24 postoperative hours, decreasing on subsequent days. If not adequately treated, it may lead to impaired ventilation, hemodynamic complications, arrhythmia, hypoxemia, myocardial ischemia or infarction, cerebrovascular accidents, thromboembolism, wound healing, delayed extubation, increased hospital length of stay, and increased mortality and morbidity. The use of opioids is related to nausea, vomiting, ileus, sedation, and respiratory depression in contrast to the Enhanced Recovery After Surgery protocols. Inappropriate postoperative pain management may result in acute and chronic pain, immunosuppression, and infections depending on surgical procedures and trauma, anesthetic techniques, extracorporeal circulation, age, sex, and perioperative anxiety. Knowledge and understanding of physiological disorders and pathophysiological pain mechanisms such as the development of ultrasound chest wall blocks and multimodal opioid-sparing protocols in the era of fast track and ERAS are crucial to improve comfort and early treatment and outcomes of patients.