Intrathecal morphine after cardiac surgery

OBJECTIVE: To assess whether intrathecal (IT) analgesia facilitates early extubation and provides superior pain control after cardiac surgery compared with patient-controlled analgesia (PCA) or nurse-administered SC injections. METHODS: Sixty-two patients undergoing elective cardiac surgery participated in this prospective, randomized, partly-blinded study. Perioperative care was standardized, and patients were assigned to receive IT morphine (ITM group) followed by PCA, IT placebo (ITP group) followed by PCA, or SC injections of morphine every 4 hours as needed (SC group). Rating scales and questionnaires were used to assess clinical outcomes. RESULTS: ITM did not favor earlier extubation, and there was even a tendency for longer extubation times in the ITM group compared with the ITP and SC groups. Pain scores, adverse effects, postoperative recovery, and patient satisfaction were also comparable in the 3 groups. CONCLUSIONS: Considering that the administration of IT morphine is more costly and can be riskier than conventional analgesic regimens, we conclude that its use is not indicated in patients undergoing cardiac surgery if early extubation is planned.

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