Nalbuphine for Severe Pain in Post-CABG Patients

Primary Recommendation

• The American College of Cardiology and American Heart Association emphasize that multidisciplinary efforts to ensure optimal analgesia throughout the perioperative period are indicated (Class I recommendation) 1, 2

Comparison to Guideline-Preferred Opioids

• High-dose intraoperative morphine (40 mg) offers superior postoperative pain relief compared to fentanyl, according to the American College of Cardiology 1, 3
• Fentanyl provides rapid onset and shorter duration, making it a good morphine alternative, as suggested by the American College of Cardiology 3

Critical Pitfalls to Avoid

• The American College of Cardiology and American Heart Association recommend never using COX-2 inhibitors (Class III: HARM recommendation) in post-CABG patients due to increased cardiovascular events 1, 4, 3
• The American College of Cardiology suggests avoiding tramadol when possible due to higher delirium risk 3
• Excessive opioid dosing should be avoided, which can cause opioid-induced hyperalgesia, as recommended by the American College of Cardiology 3