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Intrathecal morphine plus general anesthesia in cardiac surgery: effects on pulmonary function, postoperative analgesia, and plasma morphine concentration
Santos, Luciana Moraes dos; Santos, Verônica Cavani Jorge; Santos, Silvia Regina Cavani Jorge; Malbouisson, Luiz Marcelo Sá; Carmona, Maria José Carvalho.
Afiliação
  • Santos, Luciana Moraes dos; Universidade de São Paulo. Faculdade de Medicina. Heart Institute. Department of Anesthesia. São Paulo. BR
  • Santos, Verônica Cavani Jorge; Universidade de Sao Paulo. Pharmaceutical Sciences School. Department of Clinical Pharmacology. São Paulo. BR
  • Santos, Silvia Regina Cavani Jorge; Universidade de Sao Paulo. Pharmaceutical Sciences School. Department of Clinical Pharmacology. São Paulo. BR
  • Malbouisson, Luiz Marcelo Sá; Universidade de Sao Paulo. Pharmaceutical Sciences School. Department of Clinical Pharmacology. São Paulo. BR
  • Carmona, Maria José Carvalho; Universidade de São Paulo. Faculdade de Medicina. Heart Institute. Department of Anesthesia. São Paulo. BR
Clinics ; Clinics;64(4): 279-285, 2009. graf, tab
Article em En | LILACS | ID: lil-511927
Biblioteca responsável: BR1.1
ABSTRACT

OBJECTIVES:

To evaluate the effects of intrathecal morphine on pulmonary function, analgesia, and morphine plasma concentrations after cardiac surgery.

INTRODUCTION:

Lung dysfunction increases morbidity and mortality after cardiac surgery. Regional analgesia may improve pulmonary outcomes by reducing pain, but the occurrence of this benefit remains controversial.

METHODS:

Forty-two patients were randomized for general anesthesia (control group n=22) or 400 µg of intrathecal morphine followed by general anesthesia (morphine group n=20). Postoperative analgesia was accomplished with an intravenous, patient-controlled morphine pump. Blood gas measurements, forced vital capacity (FVC), forced expiratory volume (FEV), and FVC/FEV ratio were obtained preoperatively, as well as on the first and second postoperative days. Pain at rest, profound inspiration, amount of coughing, morphine solicitation, consumption, and plasma morphine concentration were evaluated for 36 hours postoperatively. Statistical analyses were performed using the repeated measures ANOVA or Mann-Whiney tests (*p<0.05).

RESULTS:

Both groups experienced reduced FVC postoperatively (3.24 L to 1.38 L in control group; 2.72 L to 1.18 L in morphine group), with no significant decreases observed between groups. The two groups also exhibited similar results for FEV1 (p=0.085), FEV1/FVC (p=0.68) and PaO2/FiO2 ratio (p=0.08). The morphine group reported less pain intensity (evaluated using a visual numeric scale), especially when coughing (18 hours postoperatively control group= 4.73 and morphine group= 1.80, p=0.001). Cumulative morphine consumption was reduced after 18 hours in the morphine group (control group= 20.14 and morphine group= 14.20 mg, p=0.037). The plasma morphine concentration was also reduced in the morphine group 24 hours after surgery (control group= 15.87 ng.mL-1 and morphine group= 4.08 ng.mL-1, p=0.029).

CONCLUSIONS:

Intrathecal morphine administration did not ...
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Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Assunto principal: Analgésicos Opioides / Pulmão / Morfina Tipo de estudo: Clinical_trials Limite: Female / Humans / Male Idioma: En Revista: Clinics Assunto da revista: MEDICINA Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil
Texto completo: 1 Coleções: 01-internacional Base de dados: LILACS Assunto principal: Analgésicos Opioides / Pulmão / Morfina Tipo de estudo: Clinical_trials Limite: Female / Humans / Male Idioma: En Revista: Clinics Assunto da revista: MEDICINA Ano de publicação: 2009 Tipo de documento: Article País de afiliação: Brasil País de publicação: Brasil