Multimodal Analgesia in Cardiac Surgery (Pilot Study)

Cardiac surgery is associated with significant acute pain and a proportion of these patients
will develop chronic pain.

Opioids are the main stay of analgesia in cardiac surgery because of the safer hemodynamic
profile and sedation. However high dose narcotic use is associated with a variety of unwanted
side effects prolonging postoperative recovery. There is growing evidence for the
effectiveness of multimodal approach utilizing opiate sparing techniques for enhancing
patient recovery following surgery. Early extubation has been associated with improved
patient outcome and cost effectiveness in cardiac surgery. The investigators objective is to
assess the effectiveness of an opioid sparing multimodal approach for enhancing the recovery
in Cardiac Surgical patients. This model would use a combination of intravenous
(Dexmedetomidine, Ketamine, Lidocaine) and Spinal (Morphine) drugs. All of the above
anesthetic drugs have opioid sparing effect in surgical Patients.

Dexmedetomidine use has been associated with decreased cardiac arrhythmias and improved
neurological outcome in cardiac surgical patients. Ketamine has been linked with attenuation
of postoperative cognitive dysfunction after cardiac surgery. Both intravenous lidocaine and
spinal morphine have been shown to reduce opioid consumption in the perioperative period.

Inclusion Criteria:

- Elective CABGs and/or Valve replacements, ≥ 18 years old

Exclusion Criteria:

- Re-do cardiac surgery, Acute endocarditis, Circulatory arrest, Emergent cases, Shock,
Left Ventricular Assist Device, Transplantation, Transcatheter Aortic Valve
Replacement, contraindications for Spinal including coagulopathy and Clopidogrel
<7days, psychosis, known allergy to any of the study drugs, Preoperative liver
dysfunction (AST/ALT > 2 times normal) and Renal dysfunction (Cr > 2 mg/dL), inability
to administer spinal anesthetic, preoperative opioid use, patients who are unable to
give their own consent, expected prolonged intubation postoperatively (>12 hrs),
prisoners, pregnancy