Factors Influencing Pain Scores and Opioid Demand after Robotically Assisted Cardiac Surgery

Objective. Introduction of minimally invasive cardiac surgery anticipated the reduction in postoperative pain but little quantitative data are available on this effect. This study investigated factors influencing pain scores and opioid demand after robotically assisted cardiac procedures. Methods. Using data derived from prospective robotic cardiac surgery and anesthesia databases, we analyzed 75 patients undergoing robotic cardiac surgery between July 2021 and December 2022. Study endpoints were mean cumulative pain scores measured on a 0–10 scale and opioid use on postoperative days (PODs) 1 to 4. Pain scores and oral morphine equivalent (OME) were correlated with perioperative variables. Results. Postoperatively, 39/75 (52%) of patients were extubated in the operating room (OR) and 34/75 (45.3%) were extubated within 24 hours of surgery. Mean pain scores declined from 5.8 (SD 1.5) on POD 1 to 3.8 (SD 1.6) on POD 4 and OME fell from 34.9 (SD 29) mg to 8.2 (SD 11.8) mg. OME use correlated significantly with pain scores ($p<0.01$). Higher pain scores on postoperative day (POD) 1 were associated with diabetes ($p=0.006$), tobacco use ($p=0.006$), and extubation in the OR ($p=0.017$). Opioid utilization was higher in younger patients ($p<0.001$), heavier patients ($p=0.033$), active tobacco users ($p=0.01$), longer procedure times ($p=0.002$), and those extubated in the OR ($p<0.001$). Conclusion. Pain and opioid consumption after robotically assisted cardiac surgery are moderate but decline steadily within the first four postoperative days. Tobacco use and extubation in the OR were associated with increased pain and opioid consumption.