Postoperative Pain Management in Coronary Artery Bypass Grafting: An Integrative Review

PURPOSE

To identify pharmacological and nonpharmacological interventions adopted for pain relief in the postoperative period of coronary artery bypass graft surgery.

DESIGN

Integrative review.

METHODS

Studies published in English, Spanish, and Portuguese from January 2010 to December 2019 in Cumulative Index to Nursing and Allied Health Literature (CINAHL), Latin American and Caribbean Literature on Health Science, PubMed, and Web of Science. Two hundred studies were identified and eleven were included. Methodological analysis was performed using the Medical Education Research Study Quality Instrument.

FINDINGS

The studies found were organized into three thematic categories: pharmacological interventions (methadone, morphine, lidocaine gel, remifentanil, sufentanil, and nefopam), nonpharmacological interventions (low-level laser therapy, light-emitting diode, Class IV laser, and transcutaneous nerve stimulation) and anesthetic techniques (dexmedetomidine, ultrasound-guided pectoral nerve block, high thoracic epidural analgesia, and perioperative parasternal block with levobupivacaine).

CONCLUSIONS

A greater tendency to use drug strategies for postoperative pain relief was identified. The drugs used demonstrated efficacy and safety in the treatment of pain, with the exception of nefopam, which showed little benefit in this population. Nonpharmacological interventions, used as adjuvants to drug treatment, were shown to be safe, effective, and well tolerated by the patients.

Necrotizing Otitis Externa

Objective: Evaluate the cases of necrotizing otitis externa (NOE) with regard to gender, mean age, comorbidities, clinical presentation, involvement of cranial nerve and its resolution, isolated germs at culture of swabs or biopsies of EAM, and findings at image evaluation.

Method: The patient presented severe otalgia, auricular plenitude and right peripherical facial palsy. He submitted to a swab test and also to a biopsy of the external auditory meatus. Other examinations were requested: a complete blood count, C-reactive protein, a mastoid computer tomography, and mastoid scintigraphy.

Results: Ten patients were evaluated, 4 of them were women and 6 men. All of them had type II diabetes. The most common initial finding was external meatus polyps (90% of the cases), followed by cranial nerve palsy (50% of the cases). There was complete remission of that palsy in 51% of the cases, incomplete remission in 16%, and no remission in 33% after treatment. In most of the cases, Pseudomonas aeruginosa was found (60%). Mastoid and external auditory meatus alterations were the most common disturbance in computed tomography.

Conclusion: This case reports a patient with a cellular immunosuppression disease which appeared to have an NOE complicated by cranial nerve paralysis based on his clinical picture and complementary evaluation except for the scintigraphy study. The histopathological analysis revealed a neoplastic etiology for the ear involvement.