cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2021-2683cardiovascular-2683Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEW ARTICLESЭффективность и безопасность фармакотерапии послеоперационной боли в кардиохирургииEfficiency and safety of pharmacotherapy for postoperative pain in cardiac surgeryhttps://orcid.org/0000-0002-4496-3680СычевД. А.SychevD. A.

Член-корреспондент РАН, доктор медицинских наук, профессор, заведующий кафедрой клинической фармакологии и терапии, ректор.

Москва.

Moscow.

rmapo@rmapo.ruhttps://orcid.org/0000-0002-3748-8180МорозоваТ. Е.MorozovaT. E.

Доктор медицинских наук, профессор кафедры клинической фармакологии и пропедевтики внутренних института клинической медицины, зав. кафедрой общей врачебной практики института профессионального образования.

Москва.

Moscow.

temorozova@gmail.comhttps://orcid.org/0000-0002-2068-2470ШацкийД. А.ShatskiyD. A.

Аспирант кафедры клинической фармакологии и пропедевтики внутренних болезней института клинической медицины.

Москва.

Тел.: +7 (965) 145-69-25

Moscow.

dmshatsk@gmail.comhttps://orcid.org/0000-0001-6589-7654ШихЕ. В.ShikhE. V.

Доктор медицинских наук, профессор, заведующий кафедрой клинической фармакологии и пропедевтики внутренних болезней института клинической медицины.

Москва.

Moscow.

klinfarma@mail.ruРоссийская медицинская академия непрерывного профессионального образования Минздрава РоссииRussian Medical Academy of Continuous Professional EducationПервый Московский государственный университет имени И.М. Сеченова Министерства здравоохранения Российской Федерации (Сеченовский Университет)I.M. Sechenov First Moscow State University20211201202120326832683Copyright © Сычев Д.А., Морозова Т.Е., Шацкий Д.А., Ших Е.В., 20212021Сычев Д.А., Морозова Т.Е., Шацкий Д.А., Ших Е.В.Sychev D.A., Morozova T.E., Shatskiy D.A., Shikh E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2683

Интраоперационная травматизация анатомических структур с формированием стернотомной раны неизбежно сопровождается появлением послеоперационного болевого синдрома, что оказывает негативное влияние на течение послеоперационного периода и прогноз пациентов. На сегодняшний день болью умеренной и высокой интенсивности страдают не менее половины пациентов в раннем послеоперационном периоде после кардиохирургических вмешательств. Неадекватное обезболивание в раннем послеоперационном периоде может приводить к хронизации болевых ощущений, существенно снижающих качество жизни пациентов. Концепция мультимодальной анальгезии с применением обезболивающих препаратов различных групп является приоритетной, эффективной и безопасной методикой как после кардиохирургических вмешательств, так и в других областях хирургии. Текущая обзорная статья посвящена анализу эффективности и безопасности различных групп лекарственных препаратов для послеоперационного обезболивания в кардиохирургии.

Intraoperative injury with the formation of a sternotomy wound is inevitably accompanied by postoperative pain, which has a negative effect on the postoperative period and prognosis of patients. Today, moderate and severe pain affects at least half of patients in the early postoperative period after cardiac surgery. Inadequate pain relief in the early postoperative period can lead to chronic pain, which significantly reduces the quality of life of patients. The concept of multimodal analgesia with different painkillers is a priority, effective and safe technique both after cardiac surgery and in other areas of surgery. The current review article is devoted to the analysis of efficacy and safety of various drug groups for postoperative pain relief in cardiac surgery.

болевой синдромпослеоперационное обезболиваниекардиохирургиямультимодальная анальгезияфармакогенетикаpain syndromepostoperative pain reliefcardiac surgerymultimodal analgesiapharmacogeneticsРабота выполнена при финансовой поддержке гранта Президента Российской Федерации для государственной поддержки ведущих научных школ Российской Федерации, номер НШ-2698.2020.7, тема “Фармакогенетический подход к персонализации послеоперационного обезболивания”.This study was supported by a Russian Federation President grant for state support of leading scientific schools of the Russian Federation № SS-2698.2020.7ReferencesDolin S, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409-23. doi:10.1093/bja/89.3.409.Dolin S, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409-23. doi:10.1093/bja/89.3.409.Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalized adult patients: a systematic review. J Clin Nurs. 2016;25(5-6):583-98. doi:10.1111/jocn.13094.Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalized adult patients: a systematic review. J Clin Nurs. 2016;25(5-6):583-98. doi:10.1111/jocn.13094.Choiniere M, Watt-Watson J, Victor JC, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. CMAJ. 2014;186(7):213-23. doi:10.1503/cmaj.131012.Choiniere M, Watt-Watson J, Victor JC, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. CMAJ. 2014;186(7):213-23. doi:10.1503/cmaj.131012.Guimaraes-Pereira L, Reis P, Abelha F, et al. Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain. 2017;158(10):1869-85. doi:10.1097/j.pain.0000000000000997.Guimaraes-Pereira L, Reis P, Abelha F, et al. Persistent postoperative pain after cardiac surgery: a systematic review with meta-analysis regarding incidence and pain intensity. Pain. 2017;158(10):1869-85. doi:10.1097/j.pain.0000000000000997.Lauridsen MH, Kristensen AD, Hjortdal VE, et al. Chronic pain in children after cardiac surgery via sternotomy. Cardiol Young. 2014;24(5):893-9. doi:10.1017/S104795111300139X.Lauridsen MH, Kristensen AD, Hjortdal VE, et al. Chronic pain in children after cardiac surgery via sternotomy. Cardiol Young. 2014;24(5):893-9. doi:10.1017/S104795111300139X.Gjeilo KH, Stenseth R, Wahba A, et al. Chronic postsurgical pain in patients 5 years after cardiac surgery: A prospective cohort study. Eur J Pain. 2017;21(3):425-33. doi: 10.1002/ejp.918.Gjeilo KH, Stenseth R, Wahba A, et al. Chronic postsurgical pain in patients 5 years after cardiac surgery: A prospective cohort study. Eur J Pain. 2017;21(3):425-33. doi: 10.1002/ejp.918.Brennan TJ, Zahn PK, Pogatzki-Zahn EM. Mechanisms of incisional pain. Anesthesiol Clin North Am. 2005;23(1):1-20. doi:10.1016/j.atc.2004.11.009.Brennan TJ, Zahn PK, Pogatzki-Zahn EM. Mechanisms of incisional pain. Anesthesiol Clin North Am. 2005;23(1):1-20. doi:10.1016/j.atc.2004.11.009.Овечкин А.М. Хронический послеоперационный болевой синдром — подводный камень современной хирургии. Регионарная анестезия и лечение острой боли. 2016;10(1):5-18. doi:10.18821/19936508-2016-10-1-5-18.Ovechkin AM. Chronic postoperative pain syndrome — “a pitfall” of modern surgery. Regional anesthesia and acute pain management. 2016;10(1):5-18. (In Russ)Chapman CR, Donaldson GW, Davis JJ, et al. Improving individual measurement of postoperative pain: the pain trajectory. J Pain. 2011;12(2):257-62. doi:10.1016/j.jpain.2010.08.005.Chapman CR, Donaldson GW, Davis JJ, et al. Improving individual measurement of postoperative pain: the pain trajectory. J Pain. 2011;12(2):257-62. doi:10.1016/j.jpain.2010.08.005.Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14. doi:10.1016/s1526-5900(03)00716-8.Jensen MP, Chen C, Brugger AM. Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain. 2003;4(7):407-14. doi:10.1016/s1526-5900(03)00716-8.Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-93. doi:10.1016/j.jpainsymman.2010.08.016.Hjermstad MJ, Fayers PM, Haugen DF, et al. Studies comparing Numerical Rating Scales, Verbal Rating Scales, and Visual Analogue Scales for assessment of pain intensity in adults: a systematic literature review. J Pain Symptom Manage. 2011;41(6):1073-93. doi:10.1016/j.jpainsymman.2010.08.016.Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306. doi:10.1097/CCM.0b013e3182783b72.Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306. doi:10.1097/CCM.0b013e3182783b72.Овечкин А. М., Баялиева А. Ж., Ежевская А.А. и др. Послеоперационное обезболивание. Клинические рекомендации. Вестник интенсивной терапии им. А.И. Салтанова. 2019;4:9-33. doi:10.21320/1818-474X-2019-4-9-33.Ovechkin AM, Bayalieva AZ, Ezhevskaya AA, et al. Postoperative analgesia. Annals of critical care. 2019;4:9-33. (In Russ).Meyer-FrieBem CH, Szalaty P, Zahn PK, et al. A prospective study of patients' pain intensity after cardiac surgery and a qualitative review: effects of examiners' gender on patient reporting. Scand J Pain. 2019;28;19(1):39-51. doi:10.1515/sjpain-2018-0111.Meyer-FrieBem CH, Szalaty P, Zahn PK, et al. A prospective study of patients' pain intensity after cardiac surgery and a qualitative review: effects of examiners' gender on patient reporting. Scand J Pain. 2019;28;19(1):39-51. doi:10.1515/sjpain-2018-0111.Roca J, Valero R, Gomar C. Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment. Rev Esp Anestesiol Reanim. 2017;64(7):391-400. doi:10.1016/j.redar.2017.01.002.Roca J, Valero R, Gomar C. Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment. Rev Esp Anestesiol Reanim. 2017;64(7):391-400. doi:10.1016/j.redar.2017.01.002.Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33. doi:10.1093/ejcts/ezx314.Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg. 2018;53(1):5-33. doi:10.1093/ejcts/ezx314.Rafiq S, Steinbruchel DA, Wanscher MJ, et al. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothorac Surg. 2014;20;9:52. doi:10.1186/1749-8090-9-52.17 Rafiq S, Steinbruchel DA, Wanscher MJ, et al. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothorac Surg. 2014;20;9:52. doi:10.1186/1749-8090-9-52.Lee LA, Caplan RA, Stephens LS, et al. Postoperative opioid-induced respiratory depression a closed claims analysis. Anesthesiology. 2015;122(3):659-65. doi:10.1097/ALN.0000000000000564.Lee LA, Caplan RA, Stephens LS, et al. Postoperative opioid-induced respiratory depression a closed claims analysis. Anesthesiology. 2015;122(3):659-65. doi:10.1097/ALN.0000000000000564.Rong LQ, Kamel MK, Rahouma M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A meta-analysis. J Clin Anesth. 2019;57:57-62. doi:10.1016/j.jclinane.2019.03.009.Rong LQ, Kamel MK, Rahouma M, et al. High-dose versus low-dose opioid anesthesia in adult cardiac surgery: A meta-analysis. J Clin Anesth. 2019;57:57-62. doi:10.1016/j.jclinane.2019.03.009.Brown CR, Chen Z, Khurshan F, et al. Development of Persistent Opioid Use After Cardiac Surgery. JAMA Cardiol. 2020;5(8):889-96. doi:10.1001/jamacardio.2020.1445.Brown CR, Chen Z, Khurshan F, et al. Development of Persistent Opioid Use After Cardiac Surgery. JAMA Cardiol. 2020;5(8):889-96. doi:10.1001/jamacardio.2020.1445.Kirchheiner J, Keulen JT, Bauer S, et al. Effects of the CYP2D6 gene duplication on the pharmacokinetics and pharmacodynamics of tramadol. J Clin Psychopharmacol. 2008;28(1):78-83. doi:10.1097/JCP.0b013e318160f827.Kirchheiner J, Keulen JT, Bauer S, et al. Effects of the CYP2D6 gene duplication on the pharmacokinetics and pharmacodynamics of tramadol. J Clin Psychopharmacol. 2008;28(1):78-83. doi:10.1097/JCP.0b013e318160f827.Chou WY, Yang LC, Lu HF, et al. Association of ц-opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplasty. Acta Anaesthesiol Scand. 2006;50(7):787-92. doi:10.1111/j.1399-6576.2006.01058.x.Chou WY, Yang LC, Lu HF, et al. Association of ц-opioid receptor gene polymorphism (A118G) with variations in morphine consumption for analgesia after total knee arthroplasty. Acta Anaesthesiol Scand. 2006;50(7):787-92. doi:10.1111/j.1399-6576.2006.01058.x.Botting R, Ayoub SS. COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins Leukot Essent Fatty Acids. 2005;72(2):85-7. doi:10.1016/j.plefa.2004.10.005.Botting R, Ayoub SS. COX-3 and the mechanism of action of paracetamol/acetaminophen. Prostaglandins Leukot Essent Fatty Acids. 2005;72(2):85-7. doi:10.1016/j.plefa.2004.10.005.Mamoun NF, Lin P, Zimmerman NM, et al. Intravenous acetaminophen analgesia after cardiac surgery: A randomized, blinded, controlled superiority trial. J Thorac Cardiovasc Surg. 2016;152(3):881-9.e1. doi:10.1016/j.jtcvs.2016.04.078.Mamoun NF, Lin P, Zimmerman NM, et al. Intravenous acetaminophen analgesia after cardiac surgery: A randomized, blinded, controlled superiority trial. J Thorac Cardiovasc Surg. 2016;152(3):881-9.e1. doi:10.1016/j.jtcvs.2016.04.078.Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA. 2019;321(7):686-96. doi:10.1001/jama.2019.0234.Subramaniam B, Shankar P, Shaefi S, et al. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA. 2019;321(7):686-96. doi:10.1001/jama.2019.0234.Allen KB, Borkon A, Cohen DJ, et al. Intravenous Acetaminophen Improves Outcomes After Transapical Transcatheter Aortic Valve Replacement. Innovations (Phila). 2018;13(4):287-91. doi:10.1097/IMI.0000000000000513.Allen KB, Borkon A, Cohen DJ, et al. Intravenous Acetaminophen Improves Outcomes After Transapical Transcatheter Aortic Valve Replacement. Innovations (Phila). 2018;13(4):287-91. doi:10.1097/IMI.0000000000000513.Almoghrabi OA, Brungardt JG, Helmer SD, et al. Efficacy of Intravenous Acetaminophen as Adjunct Post-Operative Analgesic in Cardiac Surgery: A Retrospective Study. Kans J Med. 2020.25;13:143-6. doi:10.17161/kjm.v13i.Almoghrabi OA, Brungardt JG, Helmer SD, et al. Efficacy of Intravenous Acetaminophen as Adjunct Post-Operative Analgesic in Cardiac Surgery: A Retrospective Study. Kans J Med. 2020.25;13:143-6. doi:10.17161/kjm.v13i.Van Driest SL, Jooste EH, Shi Y, et al. Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. JAMA Pediatr. 2018;172(7):655-63. doi:10.1001/jamapediatrics.2018.0614.Van Driest SL, Jooste EH, Shi Y, et al. Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. JAMA Pediatr. 2018;172(7):655-63. doi:10.1001/jamapediatrics.2018.0614.Pickering G, Creveaux I, Macian N, et al. Paracetamol and pain modulation by TRPV1, UGT2B15, SULT1A1 genotypes: a randomized clinical trial in healthy volunteers. Pain Med. 2020;21(4):661-9. doi:10.1093/pm/pnz03.Pickering G, Creveaux I, Macian N, et al. Paracetamol and pain modulation by TRPV1, UGT2B15, SULT1A1 genotypes: a randomized clinical trial in healthy volunteers. Pain Med. 2020;21(4):661-9. doi:10.1093/pm/pnz03.Bainbridge D, Cheng DC, Martin JE, et al. NSAID-analgesia, pain control and morbidity in cardiothoracic surgery. Can J Anaesth. 2006;53(1):46-59. doi:10.1007/BF03021527.Bainbridge D, Cheng DC, Martin JE, et al. NSAID-analgesia, pain control and morbidity in cardiothoracic surgery. Can J Anaesth. 2006;53(1):46-59. doi:10.1007/BF03021527.Engoren MC, Habib RH, Zacharias A, et al. Postoperative analgesia with ketorolac is associated with decreased mortality after isolated coronary artery bypass graft surgery in patients already receiving aspirin: a propensity-matched study. J Cardiothorac Vasc Anesth. 2007;21:820-6. doi:10.1053/j.jvca.2007.01.024.Engoren MC, Habib RH, Zacharias A, et al. Postoperative analgesia with ketorolac is associated with decreased mortality after isolated coronary artery bypass graft surgery in patients already receiving aspirin: a propensity-matched study. J Cardiothorac Vasc Anesth. 2007;21:820-6. doi:10.1053/j.jvca.2007.01.024.Eljezi V, Biboulet C, Boby H, et al. The Dose-Dependent Effects of Ketoprofen on Dynamic Pain after Open Heart Surgery. Pain Physician. 2017; 20(6):509-20.Eljezi V, Biboulet C, Boby H, et al. The Dose-Dependent Effects of Ketoprofen on Dynamic Pain after Open Heart Surgery. Pain Physician. 2017; 20(6):509-20.Dhawan N, Das S, Kiran U, et al. Effect of rectal diclofenac in reducing postoperative pain and rescue analgesia requirement after cardiac surgery. Pain Pract. 2009;9(5):385-93. doi:10.1111/j.1533-2500.2009.00299.x.Dhawan N, Das S, Kiran U, et al. Effect of rectal diclofenac in reducing postoperative pain and rescue analgesia requirement after cardiac surgery. Pain Pract. 2009;9(5):385-93. doi:10.1111/j.1533-2500.2009.00299.x.Sevuk U, Baysal E, Altindag R, et al. Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery. Vasc Health Risk Manag. 2015;30(11):373-8. doi:10.2147/VHRM.S85534.Sevuk U, Baysal E, Altindag R, et al. Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery. Vasc Health Risk Manag. 2015;30(11):373-8. doi:10.2147/VHRM.S85534.Savva DA, Kishk OA, Morgan JA, et al. Post-operative nonsteroidal anti-inflammatory drug use for pain in infant and paediatric cardiac surgery patients. Cardiol Young. 2019;29(12):1440-4. doi:10.1017/S1047951119002312.Savva DA, Kishk OA, Morgan JA, et al. Post-operative nonsteroidal anti-inflammatory drug use for pain in infant and paediatric cardiac surgery patients. Cardiol Young. 2019;29(12):1440-4. doi:10.1017/S1047951119002312.Calvo AM, Zupelari-Goncalves P, Dioni'sio TJ, et al. Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with CYP2C8*3 and CYP2C9. J Pain Res. 2017 Jul 6;10:1581-89. doi:10.2147/JPR.S138147.Calvo AM, Zupelari-Goncalves P, Dioni'sio TJ, et al. Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with CYP2C8*3 and CYP2C9. J Pain Res. 2017 Jul 6;10:1581-89. doi:10.2147/JPR.S138147.Anwar S, Cooper J, Rahman J, et al. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. Anesthesiology. 2019;131(1):119-31. doi:10.1097/ALN.0000000000002751.Anwar S, Cooper J, Rahman J, et al. Prolonged Perioperative Use of Pregabalin and Ketamine to Prevent Persistent Pain after Cardiac Surgery. Anesthesiology. 2019;131(1):119-31. doi:10.1097/ALN.0000000000002751.Rapchuk IL, O'Connell L, Liessmann CD, et al. Effect of gabapentin on pain after cardiac surgery: a randomized, double-blind, placebo-controlled trial. Anaesth Intensive Care. 2010;38(3):445-51. doi:10.1177/0310057X1003800306.Rapchuk IL, O'Connell L, Liessmann CD, et al. Effect of gabapentin on pain after cardiac surgery: a randomized, double-blind, placebo-controlled trial. Anaesth Intensive Care. 2010;38(3):445-51. doi:10.1177/0310057X1003800306.Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;21;2(2):CD009121. doi:10.1002/14651858.CD009121.pub2.Yeung JH, Gates S, Naidu BV, et al. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy. Cochrane Database Syst Rev. 2016;21;2(2):CD009121. doi:10.1002/14651858.CD009121.pub2.Landoni G, Isella F, Greco M, et al. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015;115(1):25-32. doi:10.1093/bja/aev201.Landoni G, Isella F, Greco M, et al. Benefits and risks of epidural analgesia in cardiac surgery. Br J Anaesth. 2015;115(1):25-32. doi:10.1093/bja/aev201.

The authors declare that there are no conflicts of interest present.