title: Fast-track anesthesia with remifentanil and spinal analgesia for cardiac surgery: the effect on pain control and quality of recovery.
abstract: OBJECTIVE
  To assess pain intensity and quality of postoperative recovery in patients given fast-track anesthesia and spinal analgesia versus patients treated with standard anesthesia.
  
  
  METHODS
  A prospective, randomized, controlled study.
  
  
  METHODS
  A private institution.
  
  
  METHODS
  Eighty-three patients who underwent cardiac surgery with cardiopulmonary bypass were analyzed.
  
  
  METHODS
  General anesthesia consisted of remifentanil and spinal analgesia (low-dose morphine and clonidine) for the fast-track group (FTG) and sufentanil without spinal analgesia for the control group (CG). During the postoperative period, paracetamol and patient-controlled intravenous analgesia (PCA) with morphine were given.
  
  
  RESULTS
  Postoperative pain intensity was evaluated during 48 hours with visual analog scale scores and intravenous morphine consumption. Pain impact on quality of life was assessed with the brief pain inventory (BPI) score (days 1-8), and recovery was evaluated with the quality of recovery score (QoR-40, day 4). Compared with the CG, FTG pain intensity was significantly lower 0 to 4 (p < 0.01) and 6 to 12 hours (p < 0.05) after surgery, as was their cumulative intravenous PCA morphine consumption (p = 0.01). BPI scores supported that FTG patients had significantly (p < 0.01) less "pain at its worst" on days 1 and 2, their BPI-assessed pain interfered significantly less with daily life on day 1 (p < 0.001), and their global QoR-40 score (day 4) was significantly higher (p < 0.05).
  
  
  CONCLUSIONS
  Fast-track anesthesia combined with morphine-clonidine spinal analgesia controlled postoperative pain better and obtained a better QoR than conventional analgesia.
authors.affiliation: Cardiologie Médico-Chirurgicale, Institut Arnault Tzanck, Saint-Laurent du Var, France. pierre.lena@wanadoo.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Lena
authors.forename: Norbert
authors.initials: N
authors.lastname: Balarac
authors.forename: Diane
authors.initials: D
authors.lastname: Lena
authors.forename: Arnaud
authors.initials: A
authors.lastname: De La Chapelle
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Arnulf
authors.forename: Alain
authors.initials: A
authors.lastname: Mihoubi
authors.forename: Michel
authors.initials: M
authors.lastname: Tapia
authors.forename: Francis
authors.initials: F
authors.lastname: Bonnet
mesh_terms: D000368:Aged; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous / Q000379:methods / Q000639:trends*; D000775:Anesthesia, Spinal / Q000379:methods / Q000639:trends*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods / Q000639:trends; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D016037:Single-Blind Method; D013997:Time Factors
chemical_list: D010880:Piperidines; D000077208:Remifentanil