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Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery

L’administration intrathécale combinée de sufentanil-morphine réduit la durée de l’intubation et améliore l’analgésie lors d’une intervention cardiaque “fast-track”

Canadian Journal of Anaesthesia volume 49, pages 711–717 (2002)Cite this article

Abstract

Purpose

To compare the effect of combined intrathecal morphine and sufentanil with low-doseiv sufentanil during propofol anesthesia for fast-track cardiac surgery.

Methods

Twenty-four consecutive patients with normal cardiopulmonary function who were scheduled for elective cardiac surgery were randomized to receive either a continuousiv infusion of sufentanil 0.9 to 1.8μg· kg−1· min−1 (13 patients), or a single lumbar intrathecal dose of sufentanil 50 μg and morphine 500 μg (11 patients). We prospectively studied perioperative analgesia, time to extubation and early postoperative maximal inspiratory capacity in the two groups. In the intensive care unit, the medical and nursing staff were blinded to the analgesic technique.

Results

Intrathecal sufentanil morphine allowed a shorter duration of intubation (104 ± 56.5 minvs 213 ± 104 min;P = 0.01), reduced the need for postoperative analgesia with nicomorphine (equipotentto morphine) (0.7 ± 0.4 mg· hr−1 vs 1.2 ± 0.4 mg· hr−1;P = 0.008) and improved postoperative maximal inspiratory capacity (53.4 ± 16.1vs 38.4 ± 12.5% of the norm;P = 0.05). Conclusion: In low-risk patients undergoing coronary artery bypass graft or valve surgery, combined intrathecal sufentanil and morphine with a target-controlled infusion of propofol satisfies the goals of fast-track cardiac surgery.

Résumé

But

Comparaison de l’effet de l’administration intrathécale combinée de morphine et de sufentanil avec l’administration iv de sufentanil lors d’une anesthésie à base de propofol pour la chirurgie cardiaque “fast-track”.

Méthode

Vingt-quatre patients consécutifs ayant une fonction cardiopulmonaire dans les limites de la normale ont été admis en vue d’une intervention cardiaque programmée et ont été randomisés en deux groupes distincts: l’un recevant une perfusion iv continue de 0,9 à 1,8 μg· kg−1· min−1 de sufentanil (13 patients) et l’autre une dose unique intrathécale de 50 μg de sufentanil et 500 μg de morphine (11 patients). Nous avons étudié prospectivement l’analgésie périopératoire, le délai d’extubation et la capacité inspiratoire maximale postopératoire dans ces deux groupes de patients. Aux soins intensifs, le personnel soignant médical et paramédical ignoraient la technique analgésique utilisée.

Résultats

L’administration intrathécale de sufentanil et de morphine a permis une extubation plus rapide (104 ± 56,5 min vs 213 ± 104 min; P = 0,01), une réduction des besoins analgésiques en nicomorphine (puissance équivalente à la morphine) (0,7 ± 0,4 mg· h−1 vs 1,2 ± 0,4 mg· h−1; P = 0,008) et une amélioration de la capacité inspiratoire maximale postopératoire (53,4 ± 16,1 vs 38,4 ± 12,5 % de la norme; P = 0,05).

Conclusion

Chez les patients à bas risque opératoire programmés pour des pontages aortocoronariens ou un remplacement valvulaire simple, l’administration intrathécale de morphine et sufentanil en dose unique satisfait les critères de chirurgie cardiaque “fast-track”.

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Author information

Affiliations

  1. Division of Cardiovascular Anesthesia, University Hospital of Zürich, Zürich

    Dominique A. Bettex, Daniel Schmidlin & Edith R. Schmid

  2. Division of Cardiovascular Anesthesia, University Hospital of Lausanne, Lausanne, Switzerland

    Pierre-Guy Chassot

Authors
  1. Dominique A. Bettex
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  2. Daniel Schmidlin
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  3. Pierre-Guy Chassot
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  4. Edith R. Schmid
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Correspondence to Dominique A. Bettex.

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Bettex, D.A., Schmidlin, D., Chassot, PG. et al. Intrathecal sufentanil-morphine shortens the duration of intubation and improves analgesia in fasttrack cardiac surgery. Can J Anesth 49, 711–717 (2002). https://doi.org/10.1007/BF03017451

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Keywords

  • Morphine
  • Sufentanil
  • Intrathecal Morphine
  • Early Extubation
  • Ventilatory Depression