Intrathecal morphine after cardiac surgery.
OBJECTIVE
To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections.


METHODS
Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes.


RESULTS
ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups.


CONCLUSIONS
Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.
Department of Anaesthesiology, Hôtel-Dieu du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada. lambert.busque@sympatico.ca
Aline
A
Boulanger
Sylvie
S
Perreault
Manon
M
Choinière
Ignacio
I
Priéto
Claire
C
Lavoie
Claude
C
Laflamme
D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D003422:Critical Care; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007279:Injections, Subcutaneous; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012129:Respiratory Function Tests; D018401:Sample Size
D000701:Analgesics, Opioid; D009020:Morphine