EFFICACY OF LIGNOCAINE AND MULTIMODAL ANALGESIA IN REDUCING PAIN POST-CORONARY ARTERY BYPASS GRAFTING PATIENTS

Abstract

Background: Pain after coronary artery bypass grafting (CABG) affects recovery, breathing, and risk of cardiac complications. Opioids are commonly used but carry risks such as respiratory depression and sedation, making non-opioid adjuncts worth studying. Lignocaine and paracetamol are two such options with established safety profiles.

Objective: To compare intravenous lignocaine infusion with scheduled intravenous paracetamol and tramadol for postoperative pain control in the first 24 hours after elective on-pump CABG. Methods: Fifty-two patients undergoing elective on-pump CABG were randomized into two equal groups. Group A received intravenous lignocaine infusion (1.5 mg/kg/hr for 12 hours postoperatively), and Group B received scheduled intravenous paracetamol and tramadol. All patients received standard general anesthesia and postoperative care. Pain was measured at rest and during coughing using the Numerical Rating Scale (NRS) at 0, 3, 6, 9, 12, and 24 hours after extubation.

Results: The two groups were not fully matched at baseline: the multimodal group was older (61.69 ± 10.06 vs. 54.62 ± 9.80 years, p=0.013), had more males (73.1% vs. 42.3%, p=0.025), and more kidney disease (38.5% vs. 7.7%, p=0.008). Hypertension and diabetes were similar between groups. Pain scores at rest and during coughing were comparable between groups at most time points (0, 3, 6, 9, and 24 hours). At 12 hours, the lignocaine group had significantly lower pain scores both at rest [2 (IQR 2) vs. 3 (IQR 2), p=0.044] and during coughing [2 (IQR 1.50) vs. 4 (IQR 2.25), p=0.013]. Within both groups, pain scores changed significantly over the 24-hour period (p<0.001 for all comparisons).