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Canadian Journal of Anesthesia 52:94-99 (2005)
© Canadian Anesthesiologists' Society, 2005
Cardiothoracic Anesthesia, Respiration and Airway

Low dose intrathecal morphine facilitates early extubation after cardiac surgery: results of a retrospective continuous quality improvement audit

[L’administration intrathécale d’une faible dose de morphine facilite l’extubation précoce après la cardiochirurgie : résultats d’un audit rétrospectif continu sur l’amélioration de la qualité]

Joel L. Parlow, MD FRCPC MSc, R. Geoffrey Steele, MBBS FANZCA MRCA and Deirdre O’Reilly, BPHARM MSc

From the Department of Anesthesiology, Queen’s University and Kingston General Hospital, Kingston, Ontario, Canada.

Address correspondence to: Dr. Joel Parlow, Department of Anesthesiology, Kingston General Hospital, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada. Phone: 613-548-7827; Fax: 613-548-1375; E-mail: parlowj{at}post.queensu.ca

Purpose: To document one centre’s experience with a multimodal analgesic approach, with or without low dose intrathecal morphine (ITM), in facilitating "fast-track" recovery in patients undergoing cardiac surgery.

Methods: Records of 131 consecutive patients who underwent first time elective cardiac surgery during a four-month period in 2000 were reviewed. Patients were divided into two groups: those receiving and those not receiving preoperative low dose ITM (< 5 µg•kg–1) as part of a multimodal analgesic technique. Demographic and surgical characteristics, postoperative morphine use, time to extubation and requirement for antiemetics were recorded.

Results: Overall, 75% of patients were extubated within two hours, and 93% within six hours. Fifty-five patients received, and 76 did not receive, ITM (mean ± SD 259 ± 53 µg) along with a multimodal analgesic technique (parasternal infiltration, acetaminophen and indomethacin, and postoperative iv morphine). Anesthetic technique involved modest dose opioids, volatile agent and propofol infusion. The groups were similar with respect to preoperative, intraoperative and anesthetic characteristics.

Mean extubation time for fast-track patients receiving vs not receiving ITM was 75 ± 65 vs 117 ± 85 min (P = 0.003). Intravenous morphine use for the first 12 hr after surgery was also reduced in the ITM group (4.6 ± 4.1 vs 10.0 ± 14.8 mg, P = 0.009). There was no difference in rescue antiemetic or antipruritic requirements, failed fast-tracking, or serious adverse events.

Conclusions: Multimodal postoperative analgesia allowed for uneventful early extubation and low opioid requirements. Low dose ITM further facilitated early extubation, and reduced postoperative analgesic requirements.




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D. C. H. Cheng
Regional analgesia and ultra-fast-track cardiac anesthesia/Analgesie regionale et procedure ultra-acceleree d'anesthesie cardiaque
Can J Anesth, January 1, 2005; 52(1): 12 - 17.
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