Postoperative effects of low dose intrathecal morphine in coronary artery bypass surgery

Dose Response Study of Intrathecal Morphine for Off-Pump Coronary Artery Bypass Grafting: a pilot Prospective Randomized Double-Blinded Controlled Clinical Trial

“…In a similar vein, there was a decreasing trend in the cumulative 48 hour intravenous morphine use from control to ITM-2.5 to ITM-5 groups. This was a secondary outcome and surrogate marker of the efficacy of postoperative analgesia of ITM and the trend is in keeping with both older and recent studies of postoperative analgesic efficacy of intrathecal morphine in cardiac surgery [7,14,15] although Chaney [16,17] and Roedinger et al [18] have revisited their previous conclusions [16][17][18] on the significance of ITM in post-operative analgesia. Despite not being the primary aim of this study, the findings are in agreement with the general consensus that ITM does provide significant postoperative analgesia in cardiac surgery and is superior to intravenous morphine on-demand alone.…”

“…Intrathecal Morphine (ITM) provides effective postoperative analgesia in major surgery [3,4] with a low risk of epidural haematoma [5,6]. Recent studies have shown that ITM provides effective postoperative analgesia in cardiac surgery [7,8]. But what is unclear from the literature is the minimal effective dose of ITM for cardiac surgery, especially in the context of OPCAB surgery, whose patients are suited to a fast-track extubation protocol.…”

The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review

“…Table 3 summarizes the main features and findings of the most relevant RCTs and meta-analyses of RCTs that investigated the role of neuraxial anesthesia in patients undergoing cardiac surgery with regard to postoperative outcomes. 175,[181][182][183][184][185][186][187][188][189][190][191] The most recent and comprehensive meta-analysis included 69 RCTs (4,860 patients overall) in which epidural analgesia was compared with either intravenous analgesia, peripheral nerve block, intrapleural analgesia, or wound infiltration in adult patients undergoing any cardiac surgery. 191 Among studies using systemic analgesia as a comparator, no differences were found between arms in up to 30day mortality (3,418 patients from 38 RCTs; risk difference [RD] 0.00, 95% CI À0.01 to 0.01) and in the incidence of postoperative stroke (2,232 patients from 18 RCTs; RD À0.00, 95% CI À0.01 to 0.01), and no or little difference was found in the risk of postoperative pneumonia (1,107 patients from 10 RCTs; RD À0.03, 95% CI À0.07 to 0.01).…”

Recent Advances in Postoperative Pain Therapy for Thoracic Surgery

“…To date, a low number of studies published an effective pain relief during thoracic surgery but often lacked an evidence-based design [92,95]. A study in cardiac surgery patients demonstrated effective analgesia after subarachnoidal application of morphine 7 lg/kg [96]. An intrathecal combination of morphine (200 lg) and sufentanil (20 lg) induced sudden analgesia for 24 h [93].…”