Fast-track coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine.
OBJECTIVE
Effective postoperative analgesia is a critical part of fast-track cardiac surgery. This study compared the postoperative analgesic effect of fast-track anesthesia with remifentanil and spinal morphine and clonidine with that of sufentanil anesthesia followed by patient-controlled administration of intravenous morphine.


METHODS
Prospective, blinded, randomized study.


METHODS
Single private institution.


METHODS
Forty patients selected for coronary artery bypass graft surgery allocated randomly into 2 groups.


METHODS
General anesthesia was performed with etomidate, isoflurane, cisatracurium, and either remifentanil (0.10-0.25 microg/kg/min) or sufentanil (up to 3.5 microg/kg). In the remifentanil group, patients received spinal morphine (4 microg/kg) and clonidine (1 microg/kg) before induction. Postoperatively, patients in both groups were connected to an intravenous patient-controlled analgesia (PCA) morphine pump that delivered a 1-g bolus with a 7-minute lockout interval.


RESULTS
Patients were evaluated for pain on a visual analog scale (VAS), at rest and on deep breathing, and for intravenous PCA morphine consumption during 24 hours. The intravenous PCA morphine 24-hour cumulative dose was lower in the fast-track than in the control group (15.8+/-12.6 v 32.7+/-22.3 mg, p<0.05). Before extubation, VAS scores were higher in the fast-track group, but after they were lower both at rest and during deep breathing. Extubation delay was shorter in the fast-track group (156.5+/-46.1 v 272+/-116.4 minutes, p<0.05).


CONCLUSIONS
The combination of anesthesia with remifentanil and spinal analgesia with morphine and clonidine produces effective analgesia after coronary artery surgery and a rapid extubation time.
Lena
Pierre
P
Institut Arnault Tzanck, Saint-Laurent du Var, France.
Balarac
Norbert
N
Arnulf
Jean Jacques
JJ
Bigeon
Jean Yves
JY
Tapia
Michel
M
Bonnet
Francis
F
D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D003000:Clonidine / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil
D010880:Piperidines; D009020:Morphine; D003000:Clonidine; D000077208:Remifentanil