Abstract
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 (VRS1 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.
Résumé
Objectif
Nous avons comparé les effets de l’analgésie autocontrôlée (AAC), avec ou sans une perfusion de morphine de base, sur l’analgésie postopératoire des patients extubés au bloc opératoire à la suite d’un pontage aortocoronalre.
Méthode
Soixante adultes consentants devant subir une opération de pontage aortocoronalre réglée ont été recrutés dans notre étude après l’accord du Comité d’Éthique de la Faculté. Les patients ont reçu soit de la morphine en AAC seule (Groupe AAC-A, n = 30), soit de la morphine en AAC plus une perfusion de base continue (Groupe AAC-B, n =30) pendant 24 h après l’opération. La douleur au repos selon une échelle verbale analogique (score de 0 à 10), les scores de sédation, la consommation de morphine, ainsi que les niveaux sérlques de morphine à zéro, une, deux, quatre, six, 12 et 24 h après l’opération ont été évalués. Le bilan hémodynamique et les gaz du sang ont aussi été enregistrés durant la même période.
Résultats
Il n’y avait pas de différence dans les scores de sédation entre les deux groupes. Après la première heure postopératoire l’échelle verbale analogique était en dessous de 5 dans les deux groupes. Les scores de douleurs étalent slgnlfcatlvement moins élevés dans le groupe perfusion de base; ce dernier groupe avait aussi une plus grande consommation cumulative de morphine (61,7 ± 10,9 mgvs38,5 ± 16,2 mg). Il n’y a pas eu d’épisode d’hypoxle ni d’hypertension.
Conclusion
LAAC avec la morphine réduit efficacement la douleur postopératoire en cardiochirurgie. L’ajout d’une perfusion de base de morphine améliore l’analgésie et augmente la consommation de morphine.
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Guler, T., Unlugenc, H., Gundogan, Z. et al. A background infusion of morphine enhances patient-controlled analgesia after cardiac surgery. Can J Anesth 51, 718–722 (2004). https://doi.org/10.1007/BF03018432
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DOI: https://doi.org/10.1007/BF03018432