Comparative evaluation of intrathecal morphine on postoperative course in patients undergone cardiac surgery

BACKGROUND: The use of intrathecal morphine in cardiac surgery has the potential to enhance postoperative course. Previous studies on the use of intrathecal morphine for optimizing postoperative analgesia and reducing the duration of mechanical ventilation (MV) have shown conflicting results, indicating the need for further clarification.

AIM: To compare the effects of intrathecal morphine at a dose of 200 μg on postoperative course in patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).

METHODS: This prospective single-center study enrolled 42 patients aged >18 years. Patients were divided into two groups: group 1 received anesthesia with sevoflurane and fentanyl; group 2 received intrathecal morphine (200 μg) 60 min prior to induction of general anesthesia. All patients underwent elective cardiac surgery with CPB. Postoperative parameters included acid–base status, blood gas changes, glycemia, extubation time, pain scores, complication rates, and mortality.

RESULTS: Intrathecal morphine administration resulted in a statistically significant reduction in the duration of MV from 300 (247; 435) to 200 (150; 360) min (p=0.017), a decrease in pain intensity by 2.1 points at 6 h postoperatively and by 1.7 points at 18–24 h postoperatively, as well as a reduced need for intravenous morphine administration during the first 24 h after surgery. The number needed to treat was 1.67.

CONCLUSION: The combination of general multicomponent anesthesia with intrathecal morphine contributes to a reduction in MV time, improves the quality of postoperative analgesia, and decreases the need for intravenous opioid administration in cardiac surgery patients.