Postoperative care of cardiac surgery patients: A protocolized approach towards enhanced recovery versus the conventional approach

Abstract

Background: Patients post-cardiac surgery face multiple challenges, but poorly controlled pain and atelectasis remain major issues that can prolong their recovery journey. The aim of this study was to compare two protocols of postoperative care in cardiac surgery: An enhanced recovery program consisting of high flow nasal oxygen therapy together with pectointercostal block, versus conventional postoperative care. Patients and Methods: Fifty adult participants above the age of 18, of either sex scheduled for cardiac surgery who required the utilization of cardiopulmonary bypass and median sternotomy approach, were included in the study. The participants were divided into ERAS Care group, where they received ultrasound-guided pectointercostal fascial plane block with subcutaneous local anaesthesia infiltration around the mediastinal drains and were extubated onto high flow nasal oxygen therapy (HFNO), and a Conventional (CONV) care group, where participants received fentanyl IV bolus dose followed by fentanyl IV infusion that was continued till the end of day zero and were extubated onto 6 L/min simple facemask. Results: Participants in the ERAS group had shorter ICU stay, lower numeric pain rating scale scores, less need for rescue analgesia, better oxygenation and lung aeration scores, better patient satisfaction, and less late pulmonary complications on discharge radiological screening. However, gastrointestinal complications and hospital stay were compared in both groups. Conclusion: ERAS care protocol in cardiac surgery patients led to shorter ICU ventilation periods, shorter ICU stay, better patient satisfaction and pain control, better oxygenation and lung aeration and less atelectasis on discharge radiology.