Mukherjee Chirojit, Koch Eva, Banusch Joergen, Scholz Markus, Kaisers Udo X, Ender Joerg
Department of Anesthesiology and Intensive Care Medicine II, Heartcenter, University of Leipzig, Germany.
Ann Card Anaesth. 2012 Apr-Jun;15(2):122-7. doi: 10.4103/0971-9784.95075.
Aim of our study was to evaluate the beneficial effect of low dose intrathecal morphine on postoperative analgesia, over the use of intravenous patient controlled anesthesia (PCA), in patients undergoing fast track anesthesia during minimally invasive cardiac surgical procedures. A randomized controlled trial was undertaken after approval from local ethical committee. Written informed consent was obtained from 61 patients receiving mitral or tricuspid or both surgical valve repair in minimal invasive technique. Patients were assigned randomly to 2 groups. Group 1 received general anesthesia and intravenous patient controlled analgesia (PCA) pump with Piritramide (GA group). Group 2 received a single shot of intrathecal morphine (1.5 μg/kg body weight) prior to the administration of general anesthesia (ITM group). Site of puncture was confined to lumbar (L1-2 or L2-3) intrathecal space. The amount of intravenous piritramide used in post anesthesia care unit (PACU) and the first postoperative day was defined as primary end point. Secondary end points included: time for tracheal extubation, pain and sedation scores in PACU upto third postoperative day. For statistical analysis Mann-Whitney-U Test and Fishers exact test (SPSS) were used. We found that the demand for intravenous opioids in PACU was significantly reduced in ITM group (P <0.001). Pain scores were significantly decreased in ITM group until second postoperative day (P <0.01). There was no time delay for tracheal extubation in ITM group, and sedation scores did not differ in either group. We conclude that low dose single shot intrathecal morphine provides adequate postoperative analgesia, reduces the intravenous opioid consumption during the early postoperative period and does not defer early extubation.
我们研究的目的是评估在微创心脏手术的快速通道麻醉过程中，低剂量鞘内注射吗啡相对于静脉自控镇痛（PCA）在术后镇痛方面的有益效果。在获得当地伦理委员会批准后进行了一项随机对照试验。对61例接受二尖瓣或三尖瓣或两者微创瓣膜修复手术的患者获得了书面知情同意。患者被随机分为2组。第1组接受全身麻醉和使用匹米诺定的静脉自控镇痛（PCA）泵（GA组）。第2组在全身麻醉前接受单次鞘内注射吗啡（1.5μg/kg体重）（ITM组）。穿刺部位局限于腰段（L1-2或L2-3）鞘内间隙。将麻醉后护理单元（PACU）和术后第一天使用的静脉匹米诺定的量定义为主要终点。次要终点包括：气管拔管时间、术后第三天内PACU的疼痛和镇静评分。统计分析使用Mann-Whitney-U检验和Fisher精确检验（SPSS）。我们发现ITM组PACU中静脉阿片类药物的需求量显著降低（P<0.001）。直到术后第二天，ITM组的疼痛评分显著降低（P<0.01）。ITM组气管拔管没有时间延迟，两组的镇静评分没有差异。我们得出结论，低剂量单次鞘内注射吗啡可提供充分的术后镇痛，减少术后早期静脉阿片类药物的消耗，并且不会延迟早期拔管。
