HOME

Letters to Editor

Korean J Pain 2019; 32(1): 51-52

Published online January 28, 2019 https://doi.org/10.3344/kjp.2019.32.1.51

Copyright © The Korean Pain Society.

Low level laser therapy: a promising adjunct therapeutic modality for pain control after coronary artery bypass graft surgery

Manijeh Yousefi Moghadam*

Department of Anesthesiology, Cardiac Anesthesia Fellowship, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Correspondence to: Manijeh Yousefi Moghadam. Department of Anesthesiology, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar 9613873136, Iran. Tel: +98-5144011300, Fax: +98-5144011300, ymanijeh@gmail.com

Received: April 23, 2018; Revised: May 29, 2018; Accepted: June 1, 2018

LETTERS TO EDITOR

Coronary artery bypass graft (CABG) surgery is one of the most commonly performed cardiac surgeries worldwide [1]. Despite developing new standards and advances in postoperative pain management, many patients experience considerable pain following CABG and postoperative pain continued to be undertreated in these patients [2,3].

Inadequate pain control after CABG can result in increased risk of postoperative morbidities such as pulmonary complications, psychological problems, higher myocardial oxygen consumption, ischemic events, and arrhythmia, as well as increased patients' length of hospital stay and decrease their overall satisfaction. Moreover, it can potentially trigger development of postoperative chronic pain [4]. Therefore, appropriate postoperative pain management after cardiac surgery is crucial, and using a multimodal approach, including the combination of multiple techniques such as pharmacologic and non-pharmacologic interventions for pain control, has been considered a preferred strategy [4,5].

Recently, low level laser therapy (LLLT) has been suggested as a non-pharmacological adjunct therapy to the modalities that are currently available for pain management after CABG surgery. Although the efficacy of LLLT, as a fast-growing technology for chronic pain management, has been relatively well known, using it for acute postoperative pain management is relatively new and still developing [6].

The results of a study by Fernandes et al. [7] showed the efficacy of LLLT (wavelength-660 nm) in reducing the acute postoperative pain of sternotomy after CABG surgery. In this study, patients' mean visual analogue scale (VAS) scores reduced from 6, in the second day, to 1.5 in the eighth day after surgery.

Another study by Lima et al. [8] revealed the positive analgesic effect of LLLT (wavelength-640 nm) in hyperglycemic and normoglycemic patients who underwent CABG surgery (patients' mean VAS scores decreased significantly from 6 to 2 in the second and eighth day after surgery, respectively).

In these two studies, patients received LLLT immediately after surgery and on subsequent days 2, 4, 6, and 8, postoperatively. A study by Karlekar et al. [9] found that laser therapy (wavelength-980 nm) in the postoperative period is an effective technique for postoperative analgesia following off-pump CABG surgery. In this study, the patients' mean VAS score decreased from 7.3, before application of the laser, to 4 and 3.4 at 1 and 24 hours after laser therapy, respectively.

Although the precise mechanisms of LLLT are still unclear, promoting the release of endorphins and serotonin, promoting vasodilatation, improving the local circulation, as well as the anti-inflammatory effect of LLLT have been suggested as probable analgesic mechanisms [7,8,10]. In terms of safety, none of the abovementioned studies have reported any side effect related to application of LLLT in patients who underwent CABG surgery. Moreover, it has been revealed that using LLLT in the postoperative period after CABG can decrease patients' myocardial damage and promote their cardiac tissue regeneration and repair [11].

In conclusion, it seems that LLLT can be used as a non-invasive, easily applied, effective, and safe adjunct therapeutic modality for postoperative pain control after CABG surgery. However, further well-design studies are warranted to determine and confirm the potential clinical value of LLLT for postoperative pain management after CABG surgery, as well as its optimal choice of parameters such as power density, wavelength, pulse structure, and influence/timing of the irradiation, which can influence the effectiveness of this therapeutic modality.

References

  1. Habibi, MR, Baradari, AG, Soleimani, A, Emami Zeydi, A, Nia, HS, Habibi, A, et al. Hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in coronary artery bypass graft surgery patients with low ejection fraction: a double-blind, randomized, clinical trial. J Clin Diagn Res, 2014;8;GC01-GC05.
  2. Totonchi, Z, Seifi, S, Chitsazan, M, Alizadeh Ghavidel, A, Baazm, F, Faritus, SZ. Pain location and intensity during the first week following coronary artery bypass graft surgery. Anesth Pain Med.
    Pubmed
  3. Hasanzadeh Kiabi, F, Soleimani, A, Habibi, MR, Emami Zeydi, A. Can vitamin C be used as an adjuvant for managing postoperative pain? A short literature review. Korean J Pain, 2013;26;209-210.
    Pubmed
  4. Huang, AP, Sakata, RK. Pain after sternotomy - review. Braz J Anesthesiol, 2016;66;395-401.
    Pubmed
  5. Bigeleisen, PE, Goehner, N. Novel approaches in pain management in cardiac surgery. Curr Opin Anaesthesiol, 2015;28;89-94.
    Pubmed
  6. Kingsley, JD, Demchak, T, Mathis, R. Low-level laser therapy as a treatment for chronic pain. Front Physiol, 2014;5;306.
    Pubmed
  7. Fernandes, GA, Araújo Júnior, RB, Lima, AC, Gonzaga, IC, de Oliveira, RA, Nicolau, RA. Low-intensity laser (660 NM) has analgesic effects on sternotomy of patients who underwent coronary artery bypass grafts. Ann Card Anaesth, 2017;20;52-56.
    Pubmed
  8. Lima, AC, Fernandes, GA, Gonzaga, IC, de Barros Araújo, Js, de Oliveira, RA, Nicolau, RA. Low-level laser and light-emitting diode therapy for pain control in hyperglycemic and normoglycemic patients who underwent coronary bypass surgery with internal mammary artery grafts: a randomized, double-blind study with follow-up. Photomed Laser Surg, 2016;34;244-251.
    Pubmed
  9. Karlekar, A, Bharati, S, Saxena, R, Mehta, K. Assessment of feasibility and efficacy of class IV laser therapy for postoperative pain relief in off-pump coronary artery bypass surgery patients: a pilot study. Ann Card Anaesth, 2015;18;317-322.
    Pubmed
  10. Rayegani, SM, Bayaat, M, Sedighipour, L, Samadi, B. Low intensity laser therapy: basics and clinical applications. J Lasers Med Sci, 2010;1;31-34.
  11. Kazemi Khoo, N, Babazadeh, K, Lajevardi, M, Dabaghian, FH, Mostafavi, E. Application of low-level laser therapy following coronary artery bypass grafting (CABG) surgery. J Lasers Med Sci, 2014;5;86-91.
    Pubmed