Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery

Abstract

Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.

Impact of intrathecal morphine analgesia on the incidence of pulmonary complications after cardiac surgery: a single center propensity-matched cohort study

“…It has been recently shown that, in minimal invasive cardiac surgery, 1.5 mcg/kg intrathecal morphine is sufficient to provide pain control. [ 35 ] Consistent with other studies, our findings confirmed the superior analgesia of intrathecal morphine that was associated with lower opioid requirements in cardiac surgical patients [ 20 ].…”

Regional Analgesia for Cardiac Surgery Part 1. Current status of neuraxial and paravertebral blocks for adult cardiac surgery

“…Similar benefits were demonstrated by Yapici et al with a lower dose (7 µg/kg) of intrathecal morphine. 68 Mukherjee et al 69 prospectively compared a very low dose of intrathecal morphine (1.5 µg/kg) and intravenous patient-controlled analgesia in patients undergoing minimally invasive cardiac surgery. VAS scores and narcotic consumption were reduced for 24 hours with intrathecal morphine without any differences in ventilator duration, PaCO 2 (partial pressure of carbon dioxide) levels, or sedation scores in the postoperative period between the groups.…”

Intrathecal Morphine for Analgesia in Minimally Invasive Cardiac Surgery: A Randomized, Placebo-controlled, Double-blinded Clinical Trial

“…35 The vast majority (if not all) of the clinical studies assessed by these three reviews/meta-analyses possess major methodologic design problems (small, retrospective, and others). However, two studies hint that intrathecal morphine may be uniquely beneficial in patients undergoing minimally invasive cardiac surgery, yet one is small (22 patients) and retrospective, 36 and the other is not blinded, 37 limiting interpretation of the results. Based on this set of previously published work, intrathecal morphine in cardiac surgery has been relatively disregarded.…”