The investigators objective is to assess the effectiveness of an opioid sparing multimodal approach for enhancing the recovery in Cardiac Surgical patients. This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs.
Cardiac surgery is associated with significant acute pain and a proportion of these patients will develop chronic pain. Opioids are the main stay of analgesia in cardiac surgery because of the safer hemodynamic profile and sedation. However high dose narcotic use is associated with a variety of unwanted side effects prolonging postoperative recovery. There is growing evidence for the effectiveness of multimodal approach utilizing opiate sparing techniques for enhancing patient recovery following surgery. Early extubation has been associated with improved patient outcome and cost effectiveness in cardiac surgery. The investigators objective is to assess the effectiveness of an opioid sparing multimodal approach for enhancing the recovery in Cardiac Surgical patients. This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs. All of the above anesthetic drugs have opioid sparing effect in surgical Patients. Dexmedetomidine use has been associated with decreased cardiac arrhythmias and improved neurological outcome in cardiac surgical patients. Ketamine has been linked with attenuation of postoperative cognitive dysfunction after cardiac surgery. Both intravenous lidocaine and spinal morphine have been shown to reduce opioid consumption in the perioperative period.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
3
This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs.
No changes to current practices, using unlimited narcotic medications intraoperatively.
This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs.
Virginia Commonwealth University
Richmond, Virginia, United States
Pain Scores - Numerical Rating Scale, 0-10
Pain scores recorded 24 hours post extubation by acute pain services nurses (who will be blinded)
Time frame: 24 hours
Postoperative Opioid Consumption
Opioid consumption measured in oral morphine equivalents
Time frame: 24 hours, 48 hours, 72 hours
Patient Satisfaction
Patient Satisfaction with pain management in first 24 hours post extubation - as measured by acute pain service nurses (who will be blinded)
Time frame: 24 hours, 48 hours, 72 hours, 7 days, 30 days
Extubation
Time from arrival to ICU to extubation
Time frame: Hours from arrival to ICU to endotracheal extubation (maximum of 12 hours)
ICU Length of Stay
Time frame: Days from arrival to ICU to transfer to step down or floor level of care (maximum of 30 days)
Delirium Scores
CAM-ICU scores at above time points
Time frame: 24, 48 and 72 hours
Ionotropic Requirement
Total amount ionotropes required
Time frame: Total amount ionotropes required intraoperatively (mcg); total amount ionotropes required from time of admission to ICU postoperatively to discharge from hospital (maximum 30 days)
Bowel Function
Bowel Function
Time frame: Will determine each day postoperatively if patient has had a bowel movement, measured in days (maximum 30 days)
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This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs.
This model would use a combination of intravenous (Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs.
Ionotropic Requirement
Total duration of ionotropic requirement (hours)
Time frame: Total duration ionotropes intraoperatively (hours); total amount ionotropes required from time of admission to ICU postoperatively to discharge from hospital (hours), (maximum 30 days)