title: Combination of intrathecal morphine and remifentanil infusion for fast-track anesthesia in off-pump coronary artery bypass surgery.
abstract: OBJECTIVE
  The purpose of this study was to assess the combination of intrathecal morphine and remifentanil infusion with isoflurane in off-pump coronary artery surgery, with a focus on postoperative analgesia and fast-tracking.
  
  
  METHODS
  Prospective, randomized, controlled, blinded clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Forty-six patients who underwent elective off-pump coronary artery bypass grafting.
  
  
  METHODS
  Patients were randomly assigned to receive remifentanil infusion alone (control group, n = 23) or remifentanil infusion plus 10 microg/kg of intrathecal morphine (ITM group, n = 23). Induction and maintenance anesthesia were the same in both groups. Maintenance therapy was remifentanil infusion (0.25-1 microg/kg/min) and 0.5% to 1.5% isoflurane, with adjustments according to hemodynamics. After extubation, intravenous patient-controlled analgesia with morphine (1-mg bolus and 5-minute lockout) was administered, and Wilson sedation scores, visual analog pain scores (scale, 0-100 mm) at rest and during coughing, and cumulative morphine consumption were assessed at 1, 2, 4, 8, 12, 24, and 48 hours. Examiners were unaware of patients' group identities. Anesthetic recovery parameters and opioid-related, spinal anesthesia-related, and cardiac complications were recorded.
  
  
  RESULTS
  There were no differences between the groups' intraoperative hemodynamic or anesthetic recovery findings. Pain scores and morphine consumption were significantly lower in the ITM group at all time points after extubation (p = 0.0001-0.05). Group frequencies of opioid-related and cardiac complications were similar. No patient had central neuroaxial hematoma or post-spinal tap headache.
  
  
  CONCLUSIONS
  In the setting of isoflurane anesthesia for off-pump coronary artery bypass grafting, ITM combined with remifentanil infusion provides better postoperative analgesia than does remifentanil infusion alone, and does not improve or negatively affect fast-tracking.
authors.affiliation: Department of Anesthesiology and Reanimation, Uludag University Medical School, Gorukle/Bursa, Turkey. gturker@uludag.edu.tr
authors.forename: Gurkan
authors.initials: G
authors.lastname: Turker
authors.forename: Suna
authors.initials: S
authors.lastname: Goren
authors.forename: Sukran
authors.initials: S
authors.lastname: Sahin
authors.forename: Gulsen
authors.initials: G
authors.lastname: Korfali
authors.forename: Erkan
authors.initials: E
authors.lastname: Sayan
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000758:Anesthesia; D018686:Anesthetics, Intravenous; D047549:Coronary Artery Bypass, Off-Pump; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D010880:Piperidines; D009020:Morphine; D000077208:Remifentanil