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Review
. 2025 Sep;15(9):595-609.
doi: 10.1080/17581869.2025.2532359. Epub 2025 Jul 10.

Management of analgesia in cardiac surgery

Alessandro Strumia  1 , Mario Lusini  2   3 , Fabio Costa  1 , Elisabetta Stefani  4 , Elena Cipollone  4 , Livio Cusimano  4 , Francesca Libri  4 , Massimiliano Ricci  4 , Alessandro Ruggiero  4 , Domenico Sarubbi  1 , Alessia Mattei  1 , Lorenzo Schiavoni  1 , Raffaele Barbato  3 , Ciro Mastroianni  3 , Mohamad Jawabra  2 , Felice Eugenio Agrò  1   4 , Massimo Chello  2   3 , Rita Cataldo  1   4 , Massimiliano Carassiti  1   4 , Giuseppe Pascarella  1
Affiliations
Review

Management of analgesia in cardiac surgery

Alessandro Strumia et al. Pain Manag. 2025 Sep.

Abstract

Background: Pain management in cardiac surgery remains a critical component of perioperative care, influencing recovery, patient satisfaction, and outcomes. Traditional opioid-based analgesia is associated with significant adverse effects, prompting the exploration of multimodal strategies, including regional anesthesia (RA), non-opioid analgesics, and enhanced recovery after surgery (ERAS) protocols.This review evaluates the evolution of cardiac surgery pain management, from conventional opioid-based regimens to multimodal approaches with regional anesthesia.

Methods: A comprehensive analysis of existing literature was conducted, assessing the efficacy, safety, and integration of different pain management strategies in cardiac surgery on PubMed, Google Scholar, MEDLINE, UpToDate, Embase and Web of Science until 1 November 2024. Studies on opioids, adjunct analgesics (e.g. NSAIDs, acetaminophen, ketamine, dexmedetomidine), RA techniques, and ERAS frameworks were reviewed to provide a comparative perspective.

Results: Multimodal analgesia significantly reduces opioid consumption, enhances pain control, and minimizes complications such as respiratory depression and postoperative nausea. RA techniques, including fascial plane blocks, offer promising opioid-sparing benefits. ERAS protocols further optimize recovery, yet challenges remain in standardizing approaches across institutions.

Conclusions: The future of cardiac surgery pain management lies in individualized, multimodal strategies following ERAS principles. Standardized guidelines and further research are needed to refine these protocols for widespread adoption.

Keywords: Cardiac surgery; ERAS; analgesia; perioperative management; regional anesthesia.

Plain language summary

Pain control is very important for people having heart surgery. If pain is not managed well, recovery can be slower and more difficult. For a long time, doctors have used big amounts of strong medicines called opioids (like morphine) to treat pain after surgery. While opioids work well, they can also cause problems like drowsiness, breathing issues, nausea, and a higher chance of addiction.This article looks at safer and more balanced ways to control pain after heart surgery. These include using different kinds of medicines (like acetaminophen, NSAIDs, ketamine, and others) and special types of numbing techniques called regional anesthesia. One kind of regional anesthesia, called fascial plane blocks, can help block pain in the chest area without the side effects of opioids.The review also talks about ERAS (Enhanced Recovery After Surgery) programs, which help people recover faster by using a step-by-step plan for pain control, nutrition, and movement.Overall, using a mix of treatments – instead of just opioids – can improve pain relief, reduce side effects, and help people heal faster after heart surgery. More research is still needed so that hospitals can use the best methods for every patient.

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