Pain management after coronary artery bypass graft surgery, particularly in relation to physiotherapy interventions

Abstract

The overall aim of the thesis was to evaluate physiotherapy and pain management in patients after coronary artery bypass graft (CABG) surgery and to determine the interaction between these. The thesis contains a literature review (Chapter 1), three research studies (Chapters 2-4), and a discussion (Chapter 5). The literature review provides an overview of CABG surgery, postoperative pain management and physiotherapy management. Chapter 2 reports the findings of a survey of centres in Australia and New Zealand that perform CABG surgery, to determine current physiotherapy mobility and walking management, expected clinical milestones and physiotherapists’ perception of pain severity in patients undergoing uncomplicated CABG surgery. Chapter 3 was a systematic review with meta-analyses designed to determine the effectiveness of continuous infusion of local anaesthetic (CLA) on pain and mobilisation post cardiac surgery. Chapter 4 was a prospective, multi-centre, randomised controlled trial (RCT) that evaluated the effect of continuous infusion of 0.5 % Ropivacaine via PainBuster, parasternally post CABG surgery compared to either a sham intervention of normal saline infusion via the PainBuster, or usual care. Overall, these studies have shown that a key role of physiotherapy after CABG surgery was patient mobilisation (based on the survey) and that continuous infusion of local anaesthetic agents around the wound sites after CABG surgery improved pain scores and reduced morphine requirements and time to first walk (based on the systematic review), however the randomised controlled trial of continuous infusion of local anaesthetics via PainBuster did not show a reduction of pain or an increased walking distance or shortened time to discharge from physiotherapy compared to patients who received a sham intervention or usual care. Chapter 5 summarises these main findings and discusses limitations, clinical practice implications, and suggestions for future research.