Spinal (Subarachnoid) Morphine for Off-Pump Coronary Artery Bypass Surgery

Mehta, Yatin; Kulkarni, Vinay; Juneja, Rajiv; Sharma, Krishan Kant; Mishra, Yugal; Trehan, Naresh

doi:10.1532/hsf98.20033014

Cited by 20 publications

(18 citation statements)

References 28 publications

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“…The patient population although using higher dosage of opioids had similar number of patients when compared to our study, but very few prospective randomized studies has been published to this effect. [8,9] Many substances and techniques for neuro-axial analgesia have been tried with different impact on postoperative patient comfort and morbidity. Results are expressed as median with interquartile range, or as numbers of patients; Los -Length of stay; PACU -Post anesthesia care unit; IMC -Intermediate care unit; *Sedation score in PACU on a 1-5 scale, ranging from 1 awake to 5 unraousable Compared with other opioids like sufentanil and fentanyl, morphine is less hydrophobic, therefore, the onset of an analgesic effect is delayed (45-75 minutes), with long lasting effect compared to fentanyl or sufentanil and its distribution in the cerebrospinal fluid (CSF) is also widespread.…”

Section: Methods and Proceduresmentioning

confidence: 99%

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

et al. 2012

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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.

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Section: Methods and Proceduresmentioning

confidence: 99%

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

et al. 2012

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“…34 One patient had a ventilatory frequency ,8 bpm and needed naloxone. 34 The third study had an open design, the average age of the patients was 54 yr, the dose of intrathecal morphine was 4000 mg, and postoperative pain treatment was with papaveretum. 40 One patient required naloxone to maintain an adequate tidal volume.…”

Section: Adverse Effects Related To Intrathecal Morphinementioning

confidence: 99%

Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials

Meylan

Elia

Lysakowski

et al. 2009

British Journal of Anaesthesia

200

141

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Intrathecal morphine without local anaesthetic is often added to a general anaesthetic to prevent pain after major surgery. Quantification of benefit and harm and assessment of doseresponse are needed. We performed a meta-analysis of randomized trials testing intrathecal morphine alone (without local anaesthetic) in adults undergoing major surgery under general anaesthesia. Twenty-seven studies (15 cardiac -thoracic, nine abdominal, and three spine surgery) were included; 645 patients received intrathecal morphine (dose-range, 100-4000 mg). Pain intensity at rest was decreased by 2 cm on the 10 cm visual analogue scale up to 4 h after operation and by about 1 cm at 12 and 24 h. Pain intensity on movement was decreased by 2 cm at 12 and 24 h. Opioid requirement was decreased intraoperatively, and up to 48 h after operation. Morphine-sparing at 24 h was significantly greater after abdominal surgery {weighted mean difference, 224.2 mg [95% confidence interval (CI) 229.5 to 219.0]}, compared with cardiac -thoracic surgery [29.7 mg (95% CI 217.6 to 21.80)]. The incidence of respiratory depression was increased with intrathecal morphine [odds ratio (OR) 7.86 (95% CI 1.54 -40.3)], as was the incidence of pruritus ]. There was no evidence of linear dose-responsiveness for any of the beneficial or harmful outcomes. In conclusion, intrathecal morphine decreases pain intensity at rest and on movement up to 24 h after major surgery. Morphine-sparing is more pronounced after abdominal than after cardiac -thoracic surgery. Respiratory depression remains a major safety concern. 2009; 102: 156-67 Br J Anaesth

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“…Neuraxial analgesia is associated with a shorter time of the required artificial ventilation compared with standard opioid analgesia [10][11][12] and may influence outcome and improve left ventricular function in surgical patients compared with patients who did not receive neuraxial analgesia. 13,14 Herein, we report intrathecal use of clonidine as an adjuvant analgesic remedy to treat postoperative pain effectively in patients undergoing coronary artery bypass grafting (CABG) requiring cardiopulmonary bypass (CPB).…”

mentioning

confidence: 99%

Adjuvant Therapy With Intrathecal Clonidine Improves Postoperative Pain in Patients Undergoing Coronary Artery Bypass Graft

Nader

Li²,

Döslüoglu³

et al. 2009

The Clinical Journal of Pain

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Spinal (Subarachnoid) Morphine for Off-Pump Coronary Artery Bypass Surgery

Abstract: Intrathecal morphine provided superior quality of analgesia that translated into better maintenance of postoperative lung volume determined by spirometry. This analgesic method also facilitated earlier tracheal extubation without any major respiratory or neurologic complications.

Cited by 20 publications

References 28 publications

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

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

Benefit and risk of intrathecal morphine without local anaesthetic in patients undergoing major surgery: meta-analysis of randomized trials

Adjuvant Therapy With Intrathecal Clonidine Improves Postoperative Pain in Patients Undergoing Coronary Artery Bypass Graft

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