The use of pre-operative intrathecal morphine for analgesia following coronary artery bypass surgery.
With the emergence of rapid extubation protocols following cardiac surgery, providing adequate analgesia in the early postoperative period is important. This prospective randomised double-blind study investigated the benefits of pre-operative intrathecal administration of low dose morphine in patients undergoing coronary artery bypass graft surgery. Postoperative analgesia, pulmonary function, stress response and postoperative recovery profile were assessed. Thirty patients were allocated into two groups, receiving either 500 mug of morphine intrathecally prior to anaesthesia and intravenous patient-controlled analgesia with morphine postoperatively following tracheal extubation, or only postoperative intravenous patient-controlled analgesia. In the intrathecal group, the total consumption of intravenous morphine following surgery was significantly reduced by 40% and patients reported lower pain scores at rest, during the first 24 h following extubation. Peak expiratory flow rate was greater and postoperative catecholamine release was significantly lower. Patients in the control group had a higher incidence of reduced respiratory rate following extubation.
Roediger
L
L
Department of Anaesthesia and Intensive Care Medicine, CHU de Liège, University of Liege, B-4000 Liege, Belgium. lroediger@chu.ulg.ac.be
Joris
J
J
Senard
M
M
Larbuisson
R
R
Canivet
J L
JL
Lamy
M
M
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001026:Coronary Artery Bypass; D003422:Critical Care; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004837:Epinephrine / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007278:Injections, Spinal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D009638:Norepinephrine / Q000097:blood; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care / Q000379:methods; D011229:Preanesthetic Medication; D015656:Respiratory Mechanics / Q000187:drug effects
D000701:Analgesics, Opioid; D009020:Morphine; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine