Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi, vol.10, no.2, pp.67-74, 2004 (Scopus)
The aim of the current study was to evaluate the efficacy and safety of intravenous (iv) remifentanil combined with intrathecal morphine for postoperative pain control in off-pump coronary artery bypass grafting (OPCABG) patients. Patients were randomized to receive iv remifentanil alone (Control group, n=23) or iv remifentanil plus 10 μg kg-1 of intrathecal morphine (Group ITM, n=23). General anesthesia induction was performed using the same anaesthetic technique in all patients. Maintenance of anesthesia was obtained with iv remifentanil infusion (0.25 μg kg-1 min-1) and isoflurane inhalation (0.5-1.5 %, end-tidal) which were adjusted by hemodynamic parameters in both groups. After extubation, each patient received iv patient controlled analgesia (PCA) with morphine (1 mg boluses and 5 min lockout). Wilson sedation scale, pain severity scores (VAS 0-100 mm) at rest and with coughing and cumulative PCA morphine consumption were assessed at 1, 2, 4, 8, 12, 24 ve 48. hours after extubation by the nurses unaware of the patients' study groups. Opioid-related side effects, spinal anesthesia-related complications, cardiac complications and anesthetic recovery parameters were also evaluated postoperatively. There were no differences between the two groups with respect to intraoperative hemodynamic parameters and postoperative anesthetic recovery parameters (p>0.05). VAS values (at rest and with coughing) and PCA morphine consumption were significantly lower in Group ITM when compared with the control group after the extubation (p<0.05, p<0.01, p<0.001). Thefrequency of opioid-related side effects, spinal anesthesia-related complications and cardiac complications were similar in both groups. We concluded that the combination of iv remifentanil and intrathecal morphine provided an effective postoperative analgesia in OPCABG patients without prolonging tracheal extubation.