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ISSN 2078-7170 (Electronic)

2013, Number 3

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CorSalud 2013; 5 (3)

Value of intrathecal lyophilized morphine in coronary artery bypass surgery

Hernández OR, González AO, Hidalgo MPA, Marrero FIM, Rodríguez ÁJM, Nazco HO, Barreto HD

Language: Spanish
References: 44
Page: 252-260
PDF size: 353.22 Kb.


ABSTRACT

Introduction: Subarachnoid analgesia is a useful therapeutic method in cardiac surgery.
Objective: To compare the use of subarachnoid and intravenous morphine for postoperative analgesia in coronary artery bypass surgery.
Method: A comparative longitudinal study was conducted in 40 patients, divided into two groups. The subarachnoid analgesia group received 15 mcg/kg of lyophilized morphine, and the intravenous morphine group received 0.3 mg/kg before and after surgery.
Results: Female patients predominated. The average age and weights of both groups were similar (p › 0.05). In the subarachnoid morphine group, 90% of patients had excellent analgesia at 8 hours after surgery, and it ranged between excellent and good at 12 and 24 hours, respectively. On the other hand, only 50% of patients with intravenous morphine expressed they had a good analgesia at 8 hours after the operation; and at 24 hours they all complained of inadequate or poor analgesia (p ‹ 0.05). The average total time of postoperative analgesia in the intrathecal morphine group was 24.41 hours, while in the intravenous morphine group it was 8.76 hours (p ‹ 0.01). The main side effects were itching, for both groups, and hypotension and bradycardia for the intravenous morphine group, although differences were not significant.
Conclusions: Subarachnoid morphine proved to be useful as an analgesic in coronary artery bypass surgery, with better and more prolonged analgesia than in those patients who were treated with intravenous morphine.


REFERENCES

  1. Bromage PR. The physiology and pharmacology of epidural blockade. Clin Anesth. 1969;2:45-61.

  2. Catterall W, Mackie K. Anestésicos locales. En: Goodman and Gilman. Las bases farmacológicas de la terapéutica.12th ed. México: McGraw-Hill Inter-americana; 2010. p. 353-71.

  3. Sandby-Thomas M, Sullivan G, Hall JE. A national survey into the peri-operative anaesthetic manage-ment of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia. 2008; 63(3):250-8.

  4. Stegmann GF. Cardiovascular effects of epidural morphine or ropivacaine in isoflurane-anaesthe-tised pigs during surgical devascularisation of the liver. J S Afr Vet Assoc. 2010;81(3):143-7.

  5. Sullivan JT, Grobman WA, Bauchat JR, Scavone BM, Grouper S, McCarthy RJ, et al. A randomized con-trolled trial of the effect of combined spinal-epidural analgesia on the success of external ce-phalic version for breech presentation. Int J Obstet Anesth. 2009;18(4):328-34.

  6. Visser WA, Lee RA, Gielen MJ. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesth Analg. 2008;107(2):708-21.

  7. Almeida TF, Fantoni DT, Mastrocinque S, Tatarunas AC, Imagawa VH. Epidural anesthesia with bupiva-caine, bupivacaine and fentanyl, or bupivacaine and sufentanil during intravenous administration of propofol for ovariohysterectomy in dogs. J Am Vet Med Assoc. 2007;230(1):45-51.

  8. Huang YS, Lin LC, Huh BK, Sheen MJ, Yeh CC, Wong CS, et al. Epidural clonidine for postoperative pain after total knee arthroplasty: a dose-response stu-dy. Anesth Analg. 2007;104(5):1230-5.

  9. Torres Delgado LA, Rubén Quesada M, Bayarre Vea H, Garriga Sarria EP, Pría Borras MC, Gran Álvarez M, et al. Bioestadística. En: Informática Médica. Vol. 2. La Habana. ECIMED; 2004. p. 630.

  10. 10.Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr Drug Targets. 2009;10(8): 696-706.

  11. 11.Lenkutis T, Benetis R, Sirvinskas E, Raliene L, Judic-kaite L. Effects of epidural anesthesia on intratho-racic blood volume and extravascular lung water during on-pump cardiac surgery. Perfusion. 2009; 24(4):243-8.

  12. 12.Mehta Y, Arora D, Sharma KK, Mishra Y, Wasir H, Trehan N. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery. Ann Card Anaesth. 2008;11(2):91-6.

  13. 13.Mhuircheartaigh RJ, Moore RA, McQuay HJ. Ana-lysis of individual patient data from clinical trials: epidural morphine for postoperative pain. Br J Anaesth. 2009;103(6):874-81.

  14. 14.Mulroy MF. Epidural hydromorphone: a step closer to the view from the top. Reg Anesth Pain Med. 2010;35(4):333-4.

  15. 15.Leo S, Ocampo CE, Lim Y, Sia AT. A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. Int J Obstet Anesth. 2010;19(4):357-64.

  16. 16.Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain. 2010;14(9):894 e1-9.

  17. 17.Skupski DW, Abramovitz S, Samuels J, Pressimone V, Kjaer K. Adverse effects of combined spinal-epidural versus traditional epidural analgesia du-ring labor. Int J Gynaecol Obstet. 2009;106(3):242-5.

  18. 18.Chaney MA. Thoracic epidural anaesthesia in car-diac surgery – the current standing. Ann Card Anaesth. 2009;12(1):1-3.

  19. 19.Hansdottir V, Philip J, Olsen MF, Eduard C, Houltz E, Ricksten SE. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology. 2006;104(1):142-51.

  20. 20.Landoni G. Epidural anesthesia and analgesia in cardiac surgery. Minerva Anestesiol. 2008;74(11): 617-8.

  21. 21.Bignami E, Landoni G, Biondi-Zoccai GG, Boroli F, Messina M, Dedola E, et al. Epidural analgesia im-proves outcome in cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2010;24(4):586-97.

  22. 22.Royse CF. High thoracic epidural analgesia for cardiac surgery: time to move from morbidity to quality of recovery indicators. Ann Card Anaesth. 2009;12(2):168-9.

  23. 23.Royse CF. High thoracic epidural anaesthesia for cardiac surgery. Curr Opin Anaesthesiol. 2009; 22(1):84-7.

  24. 24.Sendasgupta C, Makhija N, Kiran U, Choudhary SK, Lakshmy R, Das SN. Caudal epidural sufentanil and bupivacaine decreases stress response in paediatric cardiac surgery. Ann Card Anaesth. 2009;12(1):27-33.

  25. 25.Tenenbein PK, Debrouwere R, Maguire D, Duke PC, Muirhead B, Enns J, et al. Thoracic epidural anal-gesia improves pulmonary function in patients undergoing cardiac surgery. Can J Anaesth. 2008; 55(6):344-50.

  26. 26.Royse C, Remedios C, Royse A. High thoracic epi-dural analgesia reduces the risk of long-term de-pression in patients undergoing coronary artery bypass surgery. Ann Thorac Cardiovasc Surg. 2007; 13(1):32-5.

  27. 27.Wijeysundera DN, Beattie WS, Austin PC, Hux JE, Laupacis A. Epidural anaesthesia and survival after intermediate-to-high risk non-cardiac surgery: a population-based cohort study. Lancet. 2008; 372(9638):562-9.

  28. 28.Bakhtiary F, Therapidis P, Dzemali O, Ak K, Acker-mann H, Meininger D, et al. Impact of high thoracic epidural anesthesia on incidence of perioperative atrial fibrillation in off-pump coronary bypass graf-ting: a prospective randomized study. J Thorac Car-diovasc Surg. 2007;134(2):460-4.

  29. 29.Bromage PR, Burfoot MF. Quality of epidural block-ade. II. Influence of physico-chemical factors; hy-aluronidase and potassium. Br J Anaesth. 1966; 38(11):857-65.

  30. 30.Dayioğlu H, Baykara ZN, Salbes A, Solak M, Toker K. Effects of adding magnesium to bupicaine and fentanyl for spinal anesthesia in knee arthroscopy. J Anesth. 2009;23(1):19-25.

  31. 31.Wang X, Zhang X, Cheng Y, Li C, Zhang W, Liu L, et al. Alpha-lipoic acid prevents bupivacaine-induced neuron injury in vitro through a PI3K/Akt-depen-dent mechanism. Neurotoxicology. 2010;31(1):101-12.

  32. 32.Singh R, Kumar N, Singh P. Randomized controlled trial comparing morphine or clonidine with bupiva-caine for caudal analgesia in children undergoing upper abdominal surgery. Br J Anaesth. 2011; 106(1):96-100.

  33. 33.Choi PT, Beattie WS, Bryson GL, Paul JE, Yang H. Effects of neuraxial blockade may be difficult to study using large randomized controlled trials: the PeriOperative Epidural Trial (POET) Pilot Study. PLoS One. 2009;4(2):e4644.

  34. 34.Davies RG, Myles PS, Graham JM. A comparison of the analgesic efficacy and side-effects of paraver-tebral vs epidural blockade for thoracotomy – a systematic review and meta-analysis of randomized trials. Br J Anaesth. 2006;96(4):418-26.

  35. 35.Horstman DJ, Riley ET, Carvalho B. A randomized trial of maximum cephalad sensory blockade with single-shot spinal compared with combined spinal-epidural techniques for cesarean delivery. Anesth Analg. 2009;108(1):240-5.

  36. 36.Macarthur A, Imarengiaye C, Tureanu L, Downey K. A randomized, double-blind, placebo-controlled

  37. trial of epidural morphine analgesia after vaginal delivery. Anesth Analg. 2010;110(1):159-64.

  38. 37.Macfarlane AJ, Pryn A, Litchfield KN, Bryden F, Young S, Weir C, et al. Randomised controlled trial of combined spinal epidural vs. spinal anaesthesia for elective caesarean section: vasopressor require-ments and cardiovascular changes. Eur J Anaesthe-siol. 2009;26(1):47-51.

  39. 38.Wang F, Shen X, Guo X, Peng Y, Gu X. Epidural analgesia in the latent phase of labor and the risk of cesarean delivery: a five-year randomized con-trolled trial. Anesthesiology. 2009;111(4):871-80.

  40. 39.Wang LZ, Chang XY, Liu X, Hu XX, Tang BL. Com-parison of bupivacaine, ropivacaine and levobupi-vacaine with sufentanil for patient-controlled epi-dural analgesia during labor: a randomized clinical trial. Chin Med J (Engl). 2010;123(2):178-83.

  41. 40.Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal sys-tems. Minerva Anestesiol. 2008;74(10):549-63.

  42. 41.Huang CH. Effect of cervical epidural blockade with 2% lidocaine plus epinephrine on respiratory func-tion. Acta Anaesthesiol Taiwan. 2007;45(4): 217-22.

  43. 42.Nolte JE, Dette F, Cassel W, Riese C, Augsten M, Koehler U. [Long-term opioid therapy and respir-atory insufficiency during sleep]. Pneumologie. 2010;64(4):241-5.

  44. 43.Ulke ZS, Senturk M. Non-analgesic effects of tho-racic epidural anesthesia. Agri. 2007;19(2):6-12.




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