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A background infusion of morphine does not enhance postoperative analgesia after cardiac surgery

[Une perfusion de morphine de base n’améliore pas l’analgésie postopératoire en cardiochirurgie]

Didem Dal, MD^*, Meral Kanbak, MD^*, Meltem Caglar, MD and Ulku Aypar, MD^*

^* From the Departments of Anesthesiology and Reanimation, and
Nuclear Medicine, Hacettepe University, Ankara, Turkey.

Address correspondence to: Dr. Didem Dal, Hacettepe University, Faculty of Medicine, Department of Anesthesiology and Reanimation, 06100 Ankara, Turkey. Phone: 90 312 3051250; Fax: 90 312 3109600; E-mail: didemdal{at}yahoo.com

Purpose: To compare the effects of patient-controlled analgesia (PCA), with or without a background infusion of morphine on postoperative pain relief and stress response after cardiac anesthesia.

Methods: With University Ethics approval, 35 consenting adults undergoing elective open-heart surgery were randomly assigned preoperatively in a double-blind fashion to receive either morphine PCA alone (Group I, n = 15) or morphine PCA plus a continuous basal infusion (Group II, n = 14) for 44 hr postoperatively. Pain scores with visual analogue scale (VAS) at rest, deep inspiration and with cough, sedation scores, stress hormone levels [cortisol, adrenocorticotropin (ACTH) and growth hormone (GH)] and morphine consumption were assessed, and serum morphine levels were measured at four, 20, 28 and 44 hr after surgery. Adverse effects including nausea, vomiting, constipation, urinary retention and pruritus were noted. Total blood, fluid requirements, drainage and urinary output were recorded.

Results: Postoperative morphine consumption at 44 hr was less in Group I (29.43 ± 12.57 mg) than in Group II (50.14 ± 16.44 mg), P = 0.0006. There was no significant difference between groups in VAS scores, GH levels, blood levels of morphine and adverse effects. While VAS scores, ACTH and GH levels decreased significantly in both groups, plasma cortisol levels increased significantly in Group I only at four hours. In Group II, ACTH and cortisol were higher at four and 44 hr respectively.

Conclusion: PCA with morphine effectively controlled postoperative pain after cardiac surgery. The addition of a background infusion of morphine did not enhance analgesia and increased morphine consumption.

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