Postoperative analgesic efficacy of epidural morphine in myocardial bypass surgery

Authors

  • Rudy Hernández Ortega Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Osvaldo González Alfonso Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Pedro A. Hidalgo Menéndez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Ilida M. Marrero Font Clínica Estomatológica "Celia Sánchez Manduley"
  • Juan M. Rodríguez Álvarez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Jorge Méndez Martínez Hospital Provincial Universitario Cardiocentro Ernesto Guevara
  • Shemanet García Cid Hospital Universitario Capitán Roberto Rodríguez Fernández
  • Miriala González Martínez Hospital Universitario Capitán Roberto Rodríguez Fernández

Keywords:

anesthesia and analgesia, epidural analgesia, morphine, bupivacaine, myocardial revascularization

Abstract

Introduction and objectives: Epidural analgesia is a Sectionstone in cardiac surgery. The aim of this study was to compare the use of lyophilized morphine and epidural bupivacaine analgesia in postoperative surgery for the surgery of the coronary arteries. Method: A prospective and inferential study was performed in 20 patients divided into two groups. The group M received epidural analgesia with 2 mg of morphine associated to 100 mg of bupivacaine and group B only bupivacaine. Results: Males were predominant. The average ages and weights of both groups were similar (p > 0,05). 90 % of the patients in group M had excellent analgesia at 8 hours after surgery and remained from good to excellent at 12 and 24 hours. While 50 % of patients in group B referred regular analgesia at 8 hours after the operation, which extended to 80% of patients at 12 hours. In the 24-hour monitoring, all patients in group B complained of poor or inadequate analgesia (p < 0,05). The average total time of postoperative analgesia obtained in group M was 28.37 hours and group B, of 8.86 hours (p < 0,01). The main adverse effects were hypotension and bradycardia. Conclusions: Morphine proved useful as an analgesic in surgery of the coronary arteries. Patients with bupivacaine and epidural morphine had better analgesia and for a longer time than patients treated with bupivacaine alone.

Downloads

Download data is not yet available.

References

1. Bromage PR. The physiology and pharmacology of epidural blockade. Clin Anesth. 1969;2:45-61.

2. Lovstad RZ, Stoen R. Postoperative epidural analgesia in children after major orthopaedic surgery. A randomised study of the effect on PONV of two anaesthetic techniques: low and high dose i.v. fentanyl and epidural infusions with and without fentanyl. Acta Anaesthesiol Scand. 2001;45(4):482-8.

3. Gurkan Y, Ozdamar D, Toker K, Solak M. Effect of preoperative epidural morphine administration on desflurane requirements during gynecologic surgery. Reg Anesth Pain Med. 2006;31(5):428-32.

4. Almeida TF, Fantoni DT, Mastrocinque S, Tatarunas AC, Imagawa VH. Epidural anesthesia with bupivacaine, bupivacaine and fentanyl, or bupivacaine and sufentanil during intravenous administration of propofol for ovariohysterectomy in dogs. J Am Vet Med Assoc. 2007;230(1):45-51.

5. Huang YS, Lin LC, Huh BK, Sheen MJ, Yeh CC, Wong CS, et al. Epidural clonidine for postoperative pain after total knee arthroplasty: a dose-response study. Anesth Analg. 2007;104(5):1230-5.

6. Meyer H, Starke A, Kehler W, Rehage J. High caudal epidural anaesthesia with local anaesthetics or alpha(2)-agonists in calves. J Vet Med A Physiol Pathol Clin Med. 2007;54(7):384-9.

7. Castro DS, Silva MF, Shih AC, Motta PP, Pires MV, Scherer PO. Comparison between the analgesic effects of morphine and tramadol delivered epidurally in cats receiving a standardized noxious stimulation. J Feline Med Surg. 2009;11(12):948-53.

8. Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr Drug Targets. 2009;10(8):696-706.

9. Fachenda K, Finucane B. Complication of Regional Anesthesia, Incidence and Prevention. Drug Safety [Internet] 2001 [citado 3 Jun 2009];24(6):[aprox. 21 p.]. Disponible en: http://adisonline.com/drugsafety/Abstract/2001/24060/Complications_of_Regional_AnaesthesiaIncidence.2.aspx

10. Catterall W, Mackie K. Anestésicos locales. En: Goodman and Gilman. Las bases farmacológicas de la terapéutica.12th ed. México: McGraw-Hill Interamericana; 2010. p. 353-71.

11. Sandby-Thomas M, Sullivan G, Hall JE. A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur. Anaesthesia. 2008;63(3):250-8.

12. Stegmann GF. Cardiovascular effects of epidural morphine or ropivacaine in isoflurane-anaesthetised pigs during surgical devascularisation of the liver. J S Afr Vet Assoc. 2010;81(3):143-7.

13. Sullivan JT, Grobman WA, Bauchat JR, Scavone BM, Grouper S, McCarthy RJ, et al. A randomized controlled trial of the effect of combined spinal-epidural analgesia on the success of external cephalic version for breech presentation. Int J Obstet Anesth. 2009;18(4):328-34.

14. Visser WA, Lee RA, Gielen MJ. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesth Analg. 2008;107(2):708-21.

15. Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol. 2008;74(10):549-63.

16. Caputo M, Alwair H, Rogers CA, Pike K, Cohen A, Monk C, et al. Thoracic epidural anesthesia improves early outcomes in patients undergoing off-pump coronary artery bypass surgery: a prospective, randomized, controlled trial. Anesthesiology. 2011;114(2):380-90.

17. Chaney MA. Thoracic epidural anaesthesia in cardiac surgery--the current standing. Ann Card Anaesth. 2009;12(1):1-3.

18. De Cosmo G, Aceto P, Gualtieri E, Congedo E. Analgesia in thoracic surgery: review. Minerva Anestesiol. 2009;75(6):393-400.

19. Hansdottir V, Philip J, Olsen MF, Eduard C, Houltz E, Ricksten SE. Thoracic epidural versus intravenous patient-controlled analgesia after cardiac surgery: a randomized controlled trial on length of hospital stay and patient-perceived quality of recovery. Anesthesiology. 2006;104(1):142-51.

20. Lagunilla J, García-Bengochea JB, Fernández AL, Álvarez J, Rubio J, Rodríguez J, et al. High thoracic epidural blockade increases myocardial oxygen availability in coronary surgery patients. Acta Anaesthesiol Scand. 2006;50(7):780-6.

21. Landoni G. Epidural anesthesia and analgesia in cardiac surgery. Minerva Anestesiol. 2008;74(11):617-8.

22. Lenkutis T, Benetis R, Sirvinskas E, Raliene L, Judickaite L. Effects of epidural anesthesia on intrathoracic blood volume and extravascular lung water during on-pump cardiac surgery. Perfusion. 2009;24(4):243-8.

23. Mehta Y, Arora D, Sharma KK, Mishra Y, Wasir H, Trehan N. Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery. Ann Card Anaesth. 2008;11(2):91-6.

24. Mhuircheartaigh RJN, Moore RA, McQuay HJ. Analysis of individual patient data from clinical trials: epidural morphine for postoperative pain. BJA. 2009;103(6):874-81.

25. Mulroy MF. Epidural hydromorphone: a step closer to the view from the top. Reg Anesth Pain Med. 2010;35(4):333-4.

26. Leo S, Ocampo CE, Lim Y, Sia AT. A randomized comparison of automated intermittent mandatory boluses with a basal infusion in combination with patient-controlled epidural analgesia for labor and delivery. Int J Obstet Anesth. 2010;19(4):357-64.

27. Kortgen A, Silomon M, Pape-Becker C, Buchinger H, Grundmann U, Bauer M. Thoracic but not lumbar epidural anaesthesia increases liver blood flow after major abdominal surgery. Eur J Anaesthesiol. 2009;26(2):111-6.

28. Panousis P, Heller AR, Koch T, Litz RJ. Epidural ropivacaine concentrations for intraoperative analgesia during major upper abdominal surgery: a prospective, randomized, double-blinded, placebo-controlled study. Anesth Analg. 2009 Jun;108(6):1971-6.

29. Singh R, Kumar N, Singh P. Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery. Br J Anaesth. 2011;106(1):96-100.

30. Macarthur A, Imarengiaye C, Tureanu L, Downey K. A randomized, double-blind, placebo-controlled trial of epidural morphine analgesia after vaginal delivery. Anesth Analg. 2010;110(1):159-64.

31. Nguyen M, Vandenbroucke F, Roy JD, Beaulieu D, Seal RF, Lapointe R, et al. Evaluation of the addition of bupivacaine to intrathecal morphine and fentanyl for postoperative pain management in laparascopic liver resection. Reg Anesth Pain Med. 2010;35(3):261-6.

32. Pekcan Z, Koc B. The post-operative analgesic effects of epidurally administered morphine and transdermal fentanyl patch after ovariohysterectomy in dogs. Vet Anaesth Analg. 2010;37(6):557-65.

33. Bonnet MP, Mignon A, Mazoit JX, Ozier Y, Marret E. Analgesic efficacy and adverse effects of epidural morphine compared to parenteral opioids after elective caesarean section: a systematic review. Eur J Pain. 2010;14(9):894 e1-9.

34. Skupski DW, Abramovitz S, Samuels J, Pressimone V, Kjaer K. Adverse effects of combined spinal-epidural versus traditional epidural analgesia during labor. Int J Gynaecol Obstet. 2009;106(3):242-5.

35. Bignami E, Landoni G, Biondi-Zoccai GG, Boroli F, Messina M, Dedola E, et al. Epidural analgesia improves outcome in cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth. 2010;24(4):586-97.

36. Bracco D, Hemmerling T. Epidural analgesia in cardiac surgery: an updated risk assessment. Heart Surg Forum. 2007;10(4):E334-7.

37. Royse CF. High thoracic epidural analgesia for cardiac surgery: time to move from morbidity to quality of recovery indicators. Ann Card Anaesth. 2009;12(2):168-9.

38. Royse CF. High thoracic epidural anaesthesia for cardiac surgery. Curr Opin Anaesthesiol. 2009;22(1):84-7.

39. Royse CF, Soeding PF, Royse AG. High thoracic epidural analgesia for cardiac surgery: an audit of 874 cases. Anaesth Intensive Care. 2007;35(3):374-7.

Published

2011-01-03

How to Cite

1.
Hernández Ortega R, González Alfonso O, Hidalgo Menéndez PA, Marrero Font IM, Rodríguez Álvarez JM, Méndez Martínez J, et al. Postoperative analgesic efficacy of epidural morphine in myocardial bypass surgery. CorSalud [Internet]. 2011 Jan. 3 [cited 2025 Sep. 11];3(1):15-2. Available from: https://revcorsalud.sld.cu/index.php/cors/article/view/1150

Issue

Section

ORIGINAL ARTICLES

Categories