Decreasing pain after cardiac surgery: Techniques for increasing patient safety and improving practice

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Jennifer Cogan

Montreal Heart Institute, Canada

: J Nurs Patient Care

Abstract

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This session will present 3 briefs: 1) the factors contributing to acute and persistent pain after cardiac surgery, 2) multimodal analgesia for post-cardiac surgery pain: traditional and novel techniques and 3) the prevalence of chronic pain 6 months after surgery and the likelihood of continued opioid use. This presentation will review the results of the most recent publications that discuss chronic post-surgical cardiac pain and offer a brief review of the modifiable and non-modifiable contributing factors. The presenter will then review the philosophy and functioning of the unique, all-inclusive and integrated model for the acute pain service, present detailed information on current protocols being used as well as the algorithms applied for patients who do not respond to the regular approach. The presenter will review several classes of medications: 1) opioids: how they are prescribed and followed, 2) local anesthetics: under what circumstances they are used postoperatively and how they are administered, 3) anticonvulsants: when they are prescribed and what dose, 4) adjuvant medications: ketamine, Flexeril, oral intravenous anti-inflammatories: indications and dosing. Additionally, in the context of the current concerns related to opioid use after surgery, the speaker will present the results of an ethics approved audit of the practice of the prevalence of ongoing use of opioids at 6 months post surgery for 320 patients. Preliminary data show that only 12% of patients filled a prescription more than 30 days after surgery and no opioid prescriptions were filled later than 3 months post surgery.

Biography

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Jennifer Cogan is a staff anesthesiologist with a Masters degree in Epidemiology from McGill University. She is the director of the acute and chronic pain service at the Montreal Heart Institute established in 2009. The service ensures optimal care for 2000 post-surgical patients per year as well as the care of patients with chronic post surgical/procedural pain and refractory angina. She has published 27 papers and presented at national and international meetings.

E-mail: cogan.jennifer@me.com