Short-term pranayama before heart surgery reduces intraoperative opioid use

Clinicians and pain doctors have investigated the effects of pranayama, an ancient yoga-based breathing technique, on the mind and body. Breathing exercises based on yoga have been shown to alleviate pain in a variety of situations, including childbirth and the recovery period after gynaecological surgery. In a comparable group of individuals, pranayama has been shown to reduce anxiety both before and after surgery. Patients who had practised short-term (5 days) pranayama (yoga training) before to having on-pump CABG/valvular surgery were more likely to need intravenous fentanyl during surgery, according to a recently published prospective randomised controlled research.

The participants were adults (ages 20-60) scheduled for on-pump CABG or valvular procedures. Patients in the study group received yoga instruction from a certified instructor (anulom-vilom pranayama (10 minutes), udgith pranayama (10 minutes), nadi shodhana pranayama (10 minutes), sheetali pranayama (5 minutes), bhramari pranayama (10 minutes), and yog nidra/relaxation (15 minutes) prior to surgery. Patients were seen for a total of five 60-minute sessions over the course of five days before they were scheduled to have surgery. Patients had cardiac surgery under general anaesthesia as per institutional protocol. After removing hypovolaemia and hypercarbia, a rapid sustained rise (>5 minutes) in HR and/or blood pressure of more than 25% from the previous trend along with BIS values of 50 was accepted as an indirect sign of "intraoperative pain." An intravenous bolus of fentanyl at 1 mcg/kg was administered to control the pain.

In the study group, short-term yoga practise resulted in reduced use of intraoperative fentanyl. This may be due to the way yoga affects the brain's neurotransmitters, namely the increased amounts of dopamine in the ventral striatum and the higher levels of the inhibitory neurotransmitter gamma amino butyric acid in the thalamic area. Mechanistically, dopamine's antinociceptive effects are mediated by D2 receptors, and the mesolimbic dopamine circuit has been demonstrated to influence response to opioids.

The current research found that the yoga group had significantly shorter postoperative mechanical breathing times and average ICU stays due to less intraoperative fentanyl intake. In India, the practise of yoga has a long history. The use of less opioids, shorter periods of mechanical breathing, and shorter stays in the intensive care unit have all been linked to implementing such measures in the preoperative phase. Quantifying the percentage decrease in opioid usage in patients practising preoperative yoga treatment for varied periods will need large-scale, multicentric, randomised controlled studies.

Reference –

Azeez, Aspari M.; Puri, Goverdhan D.1; Samra, Tanvir1,; Singh, Mahinder2. Pre-operative short-term pranayama (yoga) decreases intraoperative opioid consumption in patients undergoing on-pump cardiac surgery. Indian Journal of Anaesthesia 66(12):p 873-876, December 2022. | DOI: 10.4103/ija.ija_199_22