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A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery

[Une perfusion de morphine améliore l’analgésie autocontrôlée après cardiochirurgie]

From Departments of Anaesthesiology and Cardiovascular Surgery, Cukurova University, School of Medicine, Adana, Turkey.

Address correspondence to: Dr. Tayfun Guler, Cukurova University, School of Medicine, Department of Anaesthesiology, 01330, Balcali, Adana, Turkey. Phone: + 90 532 357 22 24; Fax: + 90 322 338 67 42; E-mail: tayguler{at}cu.edu.tr

Purpose: We compared the efficacy of patient-controlled analgesia (PCA), with or without a background infusion of morphine, on postoperative pain relief in patients extubated in the operating room after coronary artery bypass grafting (CABG) surgery.

Methods: With Faculty Ethics approval, 60 consenting adults undergoing elective coronary artery surgery were randomly assigned to receive either morphine PCA alone (group PCA-A, n = 30) or morphine PCA plus a background infusion (group PCA-B, n = 30) for 24 hr postoperatively. Pain scores with verbal rating scale (VRS; from 0 to 10) at rest, sedation scores, morphine consumption and delivery/demand ratios were assessed at zero, one, two, four, six, 12 and 24 hr after surgery. Hemodynamic variables and arterial blood gases were also recorded in the same periods.

Results: Sedation scores in the two groups were similar. At all study periods after the first postoperative hour, VRS remained below 5 in both groups. Pain scores were significantly lower in the background infusion group, which also had greater cumulative morphine consumption (61.7 ± 10.9 mg vs 38.5 ± 16.2 mg). There were no episodes of hypoxemia or hypertension.

Conclusion: Morphine PCA effectively controlled postoperative pain after cardiac surgery. The addition of a background infusion of morphine enhanced analgesia and increased morphine consumption.