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Volume 3 No. 4, October 2008 |
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Effect of Combined
Intrathecal Morphine and Clonidine on Stress Response, Extubation
Time and Postoperative Analgesia after Cardiac Surgery Department of Anesthesiology and ICU, Faculty of Medicine, Tanta University, Egypt
Tanta Med. Sc. J 2008; 3(4):142-153
Background/Aim: Pain is a major complication after cardiac surgery
if poorly controlled it leads to more complication as respiratory
depression, myocardial ischemia, delayed extubation, and more ICU
stay, with the more analgesic consumption and patients suffering.
Intrathecal morphine produces intense and prolonged analgesia. Thus
this method of administration can be useful adjunct for controlling
postoperative pain and facilitating early extubation after cardiac
surgery. The addition of intrathecal clonidine to morphine allows
the dose of intrathecal morphine to be reduced and reduces the risk
of respiratory depression while maintaining good analgesia and
allows early extubation. The aim of this study was to evaluate the
effects of combined intrathecal morphine and clonidine on stress
response, time of extubation, and postoperative analgesia after
cardiac surgery. Patients & Methods: this study was carried out on
40 patients undergoing open cardiac surgery and divided into two
groups; group (1): is the control group n. 20 and group (11): the
morphine clonidine group n.20 patients were received intrathecal
morphine 4 mcg/kg and clonidine 1mic/kg. Results: There was no
statistical significant changes in cvp, sao2, pao2and lactate level
in both groups but there was a decrease in H R after induction and
before bypass in the intrathecal morphine clonidine group compared
with the control one also there was a significant reduction in MAP
after induction, before bypass and after bypass in morphine
clonidine group Vs control group. Cortisol level was decreased after
sternotomy, after ICU admission and after extubation in the morphine
group Vs control group. Time to extubation, vas, and morphine
consumption in 24 h were all decreased in the morphine group
compared with the control one, with no significant differences in
post operative complication in both studied groups. Conclusion: The
combination of intrathecal morphine and clonidine allow the dose of
morphine to be reduced, reduces the risk of respiratory depression,
gives effective control of postoperative pain in cardiac patients
and reduce the duration of controlled ventilation. In patients with
well-preserved ventricular and respiratory function scheduled for
fast-track cardiac surgery, the use of combined intrathecal morphine
and clonidine provides superior postoperative analgesia and early
extubation.  |
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