Evaluation of the effectiveness of multimodal analgesia with low-dose opioids in reducing the need for stronger opioids (Nalbuphine) in post-operative pain management for CABG patients: A quasi-experimental study.

Abstract

Objective: To evaluate effectiveness of multimodal analgesia (MMA) with low-dose opioids in reducing postoperative pain and the need for stronger opioids (nalbuphine) in patients undergoing coronary artery bypass grafting (CABG). Study Design: Quasi-experimental study. Setting: Department of Anesthesia Peshawar Institute of Cardiology, A Tertiary Care Hospital. Period: November 2024 to March 2025. Methods: Was conducted with 30 CABG patients receiving a standardized MMA regimen (acetaminophen, gabapentin, ketorolac, and low-dose morphine) for 72 hours postoperatively. Effectiveness was defined as maintaining Visual Analog Scale (VAS) scores ≤6/10 without nalbuphine escalation. Data on pain scores, opioid consumption, mobilization time, hospital stay, and complications were analyzed using SPSS v23. Results: MMA was effective in 83.3% of patients (n=25), while 16.7% (n=5) required nalbuphine. Median VAS pain scores decreased from 4 (IQR 3-5) at 6 hours to 0 (IQR 0-0) at 72 hours. Sedation was significantly associated with effectiveness (56% vs. 0%, p=0.022). No significant associations were found with demographic or surgical variables (all p>0.05). Postoperative complications included nausea (36.7%), vomiting (23.3%), and respiratory depression (16.7%). Conclusion: MMA with low-dose opioids effectively controlled post-CABG pain in most patients, reducing the need for stronger opioids. Sedation may serve as a clinical indicator of effective analgesia.