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* BACKGROUND Postoperative pain plays a significant part in the recovery of patients after open heart surgery.
* OBJECTIVE To determine if the use of intercostal bupivacaine with epinephrine is associated with decreases in use of narcotics and intubation times after open heart surgery.
* METHODS A randomly selected experimental group of 25 patients received injections of bupivacaine with epinephrine in the intercostal tissues before chest closure in open heart surgery. A control group of 22 patients received no bupivacaine, only standard care. Postoperative use of narcotics and intubation times were determined for both groups.
* RESULTS Compared with the control group, the group given bupivacaine with epinephrine used significantly less narcotics (P =. 008) and had significantly shorter intubation times (P =. 003).
* CONCLUSION Injection of intercostal bupivacaine with epinephrine before chest closure in open heart surgery decreases use of narcotics and length of intubation postoperatively, thus speeding up recovery times. (American Journal of Critical Care. 2002; 11:433-435)
According to the American Heart Association,1 in 1999, approximately 753 000 open heart surgeries were performed in the United States. For patients who do not have complications, the mean length of stay in the hospital after open heart surgery is 4 to 6 days. The length of stay is driven in part by the duration of intubation after surgery, which may range from 2 to 24 hours or longer. The length of time a patient is intubated is affected by the amount of narcotics given postoperatively for chest discomfort during weaning from mechanical ventilation.
Literature Review
Pain after open heart surgery hinders postoperative care and extubation of patients. Alternative methods of bypass surgery are becoming popular but are not associated with a decrease in postoperative pain. In a recent case study,2 0.025% bupivacaine was injected into 2 small catheters placed in the intercostal tissues in a 56-year-old woman after open heart surgery. She was then weaned from mechanical ventilation during a period of 4 hours. The duration of mechanical ventilation was reduced by 33%.
In a study3 at the Veterans Administration Medical Center, Buffalo, NY, 133 patients who had cardiac surgery were randomized to receive either standard postoperative treatment for pain (ie, intravenous morphine; 69 patients) or intrathecal infusion of opioids (64...