Pharmacological Strategies for Postoperative Pain Control in Patients Undergoing Cardiac Surgery: A Mixed Methods Systematic Review of Clinical Efficacy, Opioid Consumption, Patient Experience, and Nursing Care.

Postoperative pain following cardiac surgery remains a major challenge that can delay recovery, increase opioid use, and hinder rehabilitation. This systematic review evaluated mixed methods evidence on pharmacological pain management strategies and their integration with nursing care in adult patients undergoing cardiac surgery. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, and Google Scholar was conducted from database inception to December 2025 following PRISMA 2020 guidelines. Four mixed methods studies met the inclusion criteria. Pharmacological interventions included opioids, paracetamol, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, dexmedetomidine, and multimodal analgesic regimens. These approaches were associated with reduced postoperative pain, 15-38% lower opioid consumption, shorter intensive care unit stays, and improved rehabilitation. Qualitative findings emphasized patients' concerns regarding opioid dependence and sedation while highlighting the importance of nurse-led education and individualized pain assessment. Overall, multimodal opioid-sparing analgesic strategies integrated with patient-centered nursing care appear to enhance postoperative recovery after cardiac surgery, although further high-quality mixed methods research is required to strengthen the evidence.