title: The effects of intrathecal morphine on patients undergoing minimally invasive direct coronary artery bypass surgery.
abstract: OBJECTIVE
  To evaluate the effects of intrathecal morphine (ITM) on the perioperative use of opiates and the fast-track pathway in patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  Twenty-two elective consecutive patients who underwent MIDCAB surgery.
  
  
  METHODS
  Eleven patients received an intrathecal injection of morphine, 7 microg/kg (ITM group, n=11), and the control group (n=11) received standard anesthesia care.
  
  
  RESULTS
  The intraoperative dose of fentanyl was 0.55+/-0.2 mg in the ITM group and 1.1+/-0.2 mg in the control group (p<0.0001). Four patients in the ITM group and none in the control group were extubated in the operating room. Extubation time was 3.2+/-4.7 hours in the ITM group and 6.3+/-3.4 hours in the control group (p=0.016). Morphine requirements in 24 hours after surgery were 2.0+/-3.5 mg in the ITM and 16.1+/-4.8 mg in the control group (p<0.0001). There were no differences in ischemic time, intraoperative fluid requirements, postoperative blood loss, and duration of surgical procedure. Hospital length of stay was shorter in the ITM group compared with the control group (3.9+/-1.7 days v 4.9+/-1.4 days, respectively, p=0.047).
  
  
  CONCLUSIONS
  ITM has to be considered in MIDCAB surgery as an effective component of the perioperative analgesia. The safety and effects of ITM in the patients recovery after MIDCAB surgery should be evaluated in further prospective studies.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Carmel Lady Davis Medical Center, Haifa, Israel. elizisman@hotmail.com
authors.forename: Eliyahu
authors.initials: E
authors.lastname: Zisman
authors.forename: Alexander
authors.initials: A
authors.lastname: Shenderey
authors.forename: Ron
authors.initials: R
authors.lastname: Ammar
authors.forename: Arieh
authors.initials: A
authors.lastname: Eden
authors.forename: Reuven
authors.initials: R
authors.lastname: Pizov
mesh_terms: D000368:Aged; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects* / Q000379:methods; D010865:Pilot Projects; D012189:Retrospective Studies
chemical_list: D009020:Morphine