MORPHINE ANALGESIA BY INTRATHECAL ROUTE IN CARDIOPULMONARY BYPASS SURGERY PATIENTS

Abstract

Introduction Prolonged intubation and stay in intensive care unit (ICU) are responsible of frequent complications [1]. Intrathecal morphine (ITM) are commonly used in general surgery and pain therapy [2]. In cardiac surgery high doses of narcotics cause delayed arousal and prolonged respiratory depression [3]. The aims of our study were to evaluate the efficacy and safety of ITM administration in adult patients undergoing cardiac surgery with cardiopulmonary bypass (CBP), in order to minimize post-operative ventilatory support, achieve adequate post-operative analgesia and decrease ICU stay. Method We enrolled 30 adult patients (21 male and 9 female) with good left ventricular performance undergoing cardiac surgery with CBP. About two hours before induction of anaesthesia, 1 mg of morphine was administrated to each patients by the intrathecal route, using a Withacre needle 25G 31/2 in the L3 - L4 or L4 - L5 interspaces, either in sitting or in lateral decubitus, according to patient's choice. Propofol, 2 mg/kg, was used for induction of anaesthesia preceded by Fentanyl (8 [micro sign]k/kg) and Pancuronium Bromide (0.1 mg/kg). Results ITM administration in cardiac surgery patients provides both intra-operative and post-operative analgesia (with earlier extubation and arousal together with a good haemodynamic stability). Efficacy of ITM was such that in no case was additional analgesia required in the ICU. Mean extubation time of 139.6 +/- 18.4 mins. represents a significant improvement over higher dose iv opiate anaesthesia. Conclusion Data obtained in the present study represent a valid contribution to improve the haemodynamic stability and the pain control in adult patients undergoing to cardiac surgery with CBP thus to allow an earlier extubation and a decrease ITU stay.