Intrathecal morphine is superior to intravenous PCA in patients undergoing minimally invasive cardiac surgery Full Text
Annals of Cardiac Anaesthesia, 04/20/2012
Mukherjee C et al. – The authors 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.Methods
- 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 (1.5µg/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.
- The authors 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.