Aim: This study aimed to compare the effectiveness and safety of fentanyl infusion with a combination of morphine, ketamine, and lidocaine (multimodal analgesia) for postoperative pain management in patients undergoing coronary artery bypass grafting (CABG).
Study Design: This randomized clinical trial was conducted from 2024 to 2025 and included 74 patients undergoing elective CABG at the study hospital. Patients received either fentanyl (500 μg/100 mL) or a combination of morphine (20 mg), ketamine (20 mg), and lidocaine (200 mg) diluted to 100 mL, administered as an infusion at 4 mL/h for the first 24 postoperative hours. Pain was assessed using the Visual Analog Scale (VAS) at 1, 4, 8, 12, 16, 20, and 24 hours after surgery. Additional recorded parameters included hemodynamic variables, respiratory depression, and the need for rescue analgesia.
Results: Patients receiving fentanyl infusion demonstrated a statistically significant greater reduction in pain scores at 4 and 8 hours postoperatively compared to those receiving the multimodal regimen. However, at the remaining assessment times (1, 12, 16, 20, and 24 hours), no significant differences in pain intensity were observed. Over the full 24-hour period, both regimens provided comparable analgesia. Additionally, no significant differences were found between the groups regarding adverse effects or the need for rescue analgesia.
Conclusions: Fentanyl infusion demonstrated greater efficacy in early postoperative pain control compared to the multimodal regimen; however, this benefit was of short duration. Over the first 24 hours following surgery, both strategies showed comparable efficacy and safety; therefore, both may be considered viable options for post-CABG analgesia.