الفهرس 
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Abstract
Optimal pain relief after cardiac surgery prevents unnecessary patient discomfort and decreases morbidity and mortality. However, achieving optimal pain relief after cardiac surgery is often difficult because of many interventions associated with cardiac surgery.
Postoperative analgesia attained via a wide variety of techniques and drugs. Traditionally, it has been obtained with intravenous opioids. However, intravenous opioids use is associated with definite detrimental side-effects.
In fact, total or optimal pain relief after cardiac surgery can not be achieved by single drug or method without major strain on equipment and surveillance systems or without significant side effects. Therefore, there was recommendation on the balanced analgesia or a multimodal approach to the treatment for that pain.
This study aimed to compare the use of different medications and techniques used alone or in combination for postoperative pain relief after cardiac surgery.
This study evaluated the benefits of the thoracic epidural technique and compared it with other modalities such as preemptive oral gabapentin, intravenous paracetamol and NSAIDs as regarding pain assessment, decreasing the total doses of morphine consumption, and postoperative nausea and vomiting in the first 24 hours after cardiac surgery.
This study involved 180 patients undergone cardiac surgery under general anesthesia divided into four groups:
In this study, (group I) sixty patients divided into two equal subgroups group IA received single oral dose of 600mg gabapentin two hours before the operation, the other subgroup group IIB received placebo two hours before the operation.
This study found that preoperative oral administration of gabapentin decreased pain scores (NRS) significantly at 2 and 24 hours post extubation, and found it non-significant at 12 & 18 hours after extubation.
This study found that administration of gabapentin was not-significant in reducing the total amount of morphine used during the first 24 hours after extubation, also it was not significantly decreasing the number of attacks of vomiting or the number of doses of antiemetic used.
In this study, (group II) sixty patients divided into two equal subgroups; subgroup IIA received 2gm of paracetamol hydrochloride in 100ml normal saline I.V. infusion immediately on arrival to the ICU, another area was dose repeated after six hours, and subgroup IIB received placebo in the form of normal saline.
This study found that the intravenous infusion of paracetamol significantly decreased the pain score (NRS) only at 2 hours after extubation, but did not significantly decrease the pain scores at 12, 18 and 24 hours after extubation.
Also, paracetamol did not significantly decrease the total morphine consumption during the first 24 hours after extubation, the number of attacks of vomiting, or the number of antiemetic doses used in the first postoperative day.
In this study, (group IV) thirty patients divided into equal three subgroups, patients received one dose of NSAID either (75mg diclofenac, 100mg ketoprofen, or 100mg indomethacin) I.M. one hour before extubation and second dose 6 hours later.
It was found in this study, that there were statistically non-significant differences among the three studied NSAIDs regarding the pain scores recorded at 2,12,18 &24 hours after extubation.
Also, it was found in this study, that there were non-significant differences among the three studied NSAIDs regarding the total morphine consumption, the number of attacks of vomiting or the number of doses of antiemetic used.
In group III (TEA), thirty patients undergoing cardiac surgery under general anesthesia with adjunctive use of TEA for intraoperative and postoperative pain relief were studied. This study compared this group with the others three groups done in this thesis, in order to evaluate the efficacy of the others three modalities in pain relief and decreasing total morphine consumption in the first 24 hours after extubation.
This study found that TEA was statistically significant in reducing pain scores in comparison to the others modalities at 2, 12, 18& 24 hours after extubation.
This study found that TEA was superior to the three others modalities and there was highly significant difference in reducing the total morphine consumption in the first 24 hours after extubation.
This study found that TEA was superior to the three others modalities and there was highly significant difference in reducing the number of attacks of vomiting in the first 24 hours after extubation.
This study found that TEA was superior to the three others modalities and there was statistically significant difference in reducing the number of doses of antiemetic used.
In conclusion, this study found that Thoracic epidural analgesia was superior to the others modalities used in this study regarding pain relief, total morphine consumption and postoperative nausea and vomiting during the first 24 hours after extubation in cardiac surgery.