Timing of invasive procedures in therapy for primary and secondary spontaneous pneumothorax

Timing of invasive procedures during chest tube therapy in spontaneous pneumothorax is undefined. Evaluation of 115 patients with primary and secondary spontaneous pneumothorax treated with tube thoracostomy revealed nearly maximal healing rates after 48 hours without a relevant increase if drainage was maintained for up to 10 days. In secondary spontaneous pneumothorax, a significantly lower healing rate was observed after 48 hours compared with primary spontaneous pneumothorax (60% vs 82%). Therapeutic success was not predictable by single clinical variables available at admission (eg, age, gender, and smoking habits) nor by their combinations. Recurrence rates were 30% in both primary and secondary spontaneous pneumothorax. Hospital stay averaged 6 days in primary and 15 days in secondary spontaneous pneumothorax. Considering their efficacy and the low incidence of complications, the early use of invasive procedures such as surgical pleurectomy, after 48 hours of persistent gas leaking, seems justified. Shorter in-patient care and lower recurrence rates may result.     

Clopidogrel does not increase bleeding and allogenic blood transfusion in coronary artery surgery.

OBJECTIVES: Platelet dysfunction is one of the major reasons of postoperative bleeding following coronary artery surgery. The aim of this study was to evaluate the effects of clopidogrel; a specific and potent irreversible inhibitor of platelet aggregation; on bleeding and use of blood and blood products after coronary artery bypass surgery (CABG). METHODS: Preoperative patient characteristics and perioperative and postoperative data were collected prospectively in 1628 consecutive patients undergoing isolated CABG performed by the same surgical and anesthesia team. Of these, 48 were receiving clopidogrel preoperatively. Of the 1628 patients, 1456 underwent elective and 172 (10.6%) underwent non-elective operation. Thirty-six (2.5%) of the elective patients and 12 (7%) of the non-elective patients were using clopidogrel, preoperatively. Baseline characteristics, chest tube output, and the need for reexploration or for blood and blood product transfusion of clopidogrel recipients and non-recipients were compared. The clopidogrel group had higher prothrombin time level (12.6+/-1.6; 11.5+/-1.7 s, (P=0.013), however comparable aPTT level (32.6+/-4.5 vs. 31.4+/-4.5 s), and platelet count (275,000+/-98,000 vs. 280,000+/-72,000 dl(-1)). RESULTS: The need for reexploration or for blood and blood product transfusion, chest tube output, ICU length of stay (20.1+/-2.9 vs. 21.9+/-13.5 h; P=NS), and hospital length of stay (5.5+/-1.7 vs. 5.4+/-2.1 days; P=NS) were similar in clopidogrel recipients and non-recipients, respectively. Further analysis demonstrated no significant difference in use of homologous blood or fresh frozen plasma, amount of postoperative bleeding and reoperation rates for bleeding as well as length of intensive care unit and hospital stay between the clopidogrel and the control groups both in elective and non-elective patients. CONCLUSIONS: The results of this study suggest that preoperative use of clopidogrel is not associated with increased bleeding and need for surgical exploration as well as risk of blood and blood product transfusion after CABG.     

Should surgical pleurectomy for spontaneous pneumothorax be always thoracoscopic?

Fifty-seven patients were studied over a period of three years to analyse the efficacy of surgical pleurectomy for spontaneous pneumothorax. Thirty-one and 26 patients underwent open and video-assisted thoracoscopic surgery (VATS) pleurectomy, respectively. VATS was the main modality used for primary spontaneous pneumothorax (PSP) (21 vs. 8). However, secondary spontaneous pneumothorax (SSP) was mainly managed with open pleurectomy (23 vs. 5). The median operating time was significantly longer in open group (72.4 vs. 55 min; P=0.005). The amount of analgesia required in the first five days was significantly more in open group (108 mg vs. 46.9 mg; P=0.02). Chest drainage was significantly more in open group (1027.1 ml vs. 652.8 ml; P=0.04). However, chest drain duration and hospital stay had no significant difference. VATS emerged as a cost-effective modality (1770 pounds vs. 3226 pounds). The ability to return to work was significantly earlier in VATS group in PSP patients (6 weeks vs. 10 weeks; P=0.007). There were 3 (5.27%) recurrences in VATS group for patients with SSP. This experience suggests that VATS pleurectomy is an appropriate modality for PSP. However, open pleurectomy is a viable alternative to treat SSP.     

Interhospital vascular surgery transfers to a tertiary care hospital

Objective

Interhospital transfers (IHTs) to tertiary care centers are linked to lower operative mortality in vascular surgery patients. However, IHT incurs great health care costs, and some transfers may be unnecessary or futile. In this study, we characterize the patterns of IHT at a tertiary care center to examine appropriateness of transfer for vascular surgery care.

低成本两孔胸腔镜手术治疗原发性气胸

目的探讨一种简单、微创、经济的腔镜方法治疗自发性气胸。 方法收集2011年10月至2016年2月胸腔镜手术治疗自发性气胸84例,其中两孔胸腔镜肺大疱结扎54例(试验组),三孔胸腔镜肺大疱切割缝合器楔形切除30例(对照组)。试验组,根据胸壁不同厚度把肺大疱拉近操作孔或拉至操作孔或拉出操作孔用手直接结扎/缝扎后做机械摩擦的胸膜固定术;对照组按常规进行,用切割缝合器行肺楔形切后做机械摩擦的胸膜固定术。 结果两组患者的临床效果差异无统计学意义(P>0.05),试验组的住院费用低于对照组[(16 747.30±2 586.41) 元 vs (21 088.54±6 005.68)元,P<0.05]。 结论两孔胸腔镜下肺大疱用手缝扎/结扎技术治疗自发性气胸简单、微创、经济。     

Manual versus digital aspiration for first-line treatment of primary spontaneous pneumothorax. The AMVADI study: a randomized clinical trial

IntroductionThe effectiveness of needle aspiration in the initial treatment of primary spontaneous pneumothorax has been widely studied. The objective of this research was to compare digital with manual aspiration in a randomized clinical trial.MethodsWe designed a blinded parallel-group randomized clinical trial with a 1:1 allocation ratio. The clinical trial is reported in line with the guidelines of the CONSORT group. The primary outcome variables were immediate success and hospital admission, while the secondary outcome measures were relapse, re-admission and need for surgery, and length of hospital stay. A satisfaction survey was also carried out among clinicians who perform these 2 types of aspiration.ResultsA total of 67 patients were included in the study (n = 36, control group; n = 31, experimental group) with no losses to follow-up. In both groups, 58% of procedures were immediately successful, avoiding hospital admission. No differences were found in rates of relapse, re-admission, need for surgery, or length of hospital stay. Overall, 80% of clinicians who performed aspiration preferred the digital system, and this preference rose to 100% among clinicians who performed more than 5 procedures a year.ConclusionsBoth manual and digital aspiration provide good immediate results avoiding hospital admission, while digital drainage is preferred by clinicians responsible for first-line treatment of pneumothorax.     

日间手术室输尿管软镜治疗上尿路结石的可行性及安全性研究

目的探讨输尿管软镜碎石取石术日间手术模式的安全性及可行性。 方法回顾性分析2016年1月至2017年7月于我中心采用输尿管软镜碎石取石术治疗上尿路结石的297例患者的临床资料,分为日间手术组141例,住院手术组156例。比较两组的术后住院时间、结石清除率、术后并发症和住院费用等指标。 结果两组性别、平均年龄、结石直径、体质量指数、术前置管、结石部位和肾下盏结石比例等指标差异无统计学意义。两组结石清除率差异无统计学意义（85.1% vs 85.9%,P=0.847）。两组术后并发症发生率差异无统计学意义（2.1% vs 5.1%,P=0.172）。日间手术组术后住院时间明显少于住院手术组[（13±4） h vs （44±25） h,P<0.001],日间手术组人均费用明显低于住院组费用[（14 946±2 302）元vs （15 568±2 364）元,P=0.022]。 结论输尿管软镜碎石取石术日间手术安全有效,显著缩短术后住院时间,降低治疗费用,有利于患者术后康复,并加快医院床位周转,提高医疗资源利用效率,值得推广。     

Impact of a regional acute care surgery model on patient access and outcomes

Background

The consolidation of acute care surgery (ACS) services at 3 of 6 hospitals in a Canadian health region sought to alleviate a relative shortage of surgeons able to take emergency call. We examined how this affected patient access and outcomes.

Methods

Using the generalized linear model and statistical process control, we analyzed ACS-related episodes that occurred between 39 months prior to and 17 months after the model’s implementation (n = 14 713).

Results

Time to surgery increased after the consolidation. Wait times increased primarily for patients presenting at nonreferral hospitals who were likely to require transfer to a referral hospital. Although ACS teams enabled referral hospitals to handle a much higher volume of patients without increasing within-hospital wait times, overall system wait times were lengthened by the growing frequency of patient transfers. Wait times for inpatient admission were difficult to interpret because there was a trend toward admitting patients directly to the ACS service, bypassing the emergency department (ED). For patients who did go through the ED, wait times for inpatient admission increased after the consolidation; however, this trend was cancelled out by the apparently zero waits of patients who bypassed the ED. Regionalization showed no impact on length of stay, readmissions, mortality or complications.

Conclusion

Consolidation enabled the region to ensure adequate surgical coverage without harming patients. The need to transfer patients who presented at nonreferral hospitals led to longer waits.     

单孔胸腔镜手术治疗自发性气胸合并进行性血胸12例报告

目的:探讨自发性气胸合并进行性血胸的病因、诊断及治疗。方法:回顾分析2011年1月至2016年9月为12例自发性气胸合并进行性血胸患者行单孔胸腔镜手术的临床资料。结果:患者均于入院48 h内行单孔胸腔镜手术,手术均顺利,患者恢复良好,中位手术时间64 min,术后中位留管时间2 d,中位住院时间5 d。随访至今,12例患者均无复发。结论:自发性血气胸应采取个体化的治疗措施,对于入院时胸片或CT检查提示为中量及以上胸腔积液的患者,应更倾向于积极进行手术治疗;单孔胸腔镜手术更具微创优势,值得推广应用。     

改良型穿刺置管对自发性气胸疗效及预后影响因素分析

目的分析改良型穿刺置管对自发性气胸的疗效及预后影响因素。 方法选取2015年4月—2016年2月在山东省菏泽市立医院胸外科接受治疗的82例自发性气胸患者,按照数字法随机分为观察组及对照组,每组41例。对照组患者给予常规粗管穿刺闭式引流治疗,观察组患者则行优化胸腔穿刺置管术治疗(一次优化操作可重复用于引流),比较两组患者的术后疗效,并分析影响患者预后疗效的危险因素。 结果观察组治疗总有效率为87.8%(36/41),显著高于对照组的68.3%(28/41),差异也有统计学意义(P<0.005)。治疗3个月后,观察组复发率为4.9%(2/41),显著低于对照组的22.0%(9/41)。观察组患者血气肿和纵隔气胸的发生率均显著低于对照组,差异均有统计学意义(4.9% vs 22.0%,P＝0.023;2.4% vs 19.5%,P＝0.013)。观察组患者住院时间和医疗费用均显著低于对照组,差异也有统计学意义[(5.4±2.1)d vs (11.2±2.4)d,P<0.001;(1 845.2±112.3)元vs (2 746.4±135.6)元,P<0.001]。Logistic回归分析显示,患者预后疗效的影响因素主要是未使用优化胸腔穿刺置管(OR＝2.636,95% CI：0.254～11.186,P<0.001)。 结论优化胸腔穿刺置管术治疗自发性气胸疗效显著,且能有效降低复发率及并发症发生率,缩短住院时间,减轻患者经济负担。     

单孔和三孔电视胸腔镜治疗自发性气胸的对比研究

目的 探讨单孔与三孔电视胸腔镜治疗自发性气胸的临床疗效.方法 回顾性分析2012年4月-2013年4月就诊于咸阳市中心医院胸外科诊断为自发性气胸的患者58例,按照随机数字表法将患者随机分配至单孔电视胸腔镜组28例,三孔电视胸腔镜组30例,并用电话随访法进行随访.采用SPSS19.0统计学软件对两组患者的临床指标、并发症发病率及生存资料进行统计学分析.结果 与传统三孔电视胸腔镜手术相比,单孔电视胸腔镜手术具有术后住院时间更短(t=-4.151,P=0.001)、引流持续时间更短(t=-3.436,P=0.001)、切口满意度评分更高(t=-6.141,P=0.001)、术后6h疼痛视觉评分更低(t=-4.942,P=0.006)、术后24 h疼痛视觉评分更低(t=-3.326,P=0.02)及术后胸腔积液的发病率更低(Z=-2.096,P=0.036)的优点,但手术时间长(t=6.369,P=0.000),在其他并发症发病率、总生存时间(x2 =0.001,P=0.979)及中位无疾病进展生存时间(x2=1.797,P=0.180)方面差异无明显统计学意义(P＞0.05).结论 与三孔电视胸腔镜手术相比,单孔电视胸腔镜手术在住院时间短、术后疼痛轻等方面具有一定的优势,但不能明显缩短手术时间和改善患者术后生活质量.     

Assessment of some performance indicators of medical departments in tertiary hospitals

The present study assesses the performance of 37 medical departments from 12 tertiary hospitals in Ia?i town during year 2001 through the following indicators: average hospital stay, utilization rate and hospital bed turnover rate. The first indicator has been analyzed by comparing the values recorded in various medical departments with those recommended by the Ministry of Health for tertiary hospitals. The highest value was recorded in the nephrology department, with a ratio 2001 value/optimal value of 2.76. Long average hospital stay has been recorded in 14 of the 37 assessed departments (37.8%). During year 2001, the following utilization rates have been found: normal rates of 300-365 inpatient days per hospital bed in 14 departments, high rates (over 365 days) in 11 departments, and low rates (less than 300) in 12 departments. Bed turnover rate varied with department's specialty profile and length of hospital stay from 11 inpatients per hospital bed in the acute mental disorders department to 146 in C intensive care unit.     

Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis.

OBJECTIVE: A prospective randomized study was undertaken to compare early with delayed laparoscopic cholecystectomy for acute cholecystitis. SUMMARY BACKGROUND DATA: Laparoscopic cholecystectomy for acute cholecystitis is associated with high complication and conversion rates. It is not known whether there is a role for initial conservative treatment followed by interval elective operation. METHOD: During a 26-month period, 99 patients with a clinical diagnosis of acute cholecystitis were randomly assigned to early laparoscopic cholecystectomy within 72 hours of admission (early group, n = 49) or delayed interval surgery after initial medical treatment (delayed group, n = 50). Thirteen patients (four in the early group and nine in the delayed group) were excluded because of refusal of operation (n = 6), misdiagnosis (n = 5), contraindication for surgery (n = 1), or loss to follow-up (n = 1). RESULTS: Eight of 41 patients in the delayed group underwent urgent operation at a median of 63 hours (range, 32 to 140 hours) after admission because of spreading peritonitis (n = 3) and persistent fever (n = 5). Although the delayed group required less frequent modifications in operative technique and a shorter operative time, there was a tendency toward a higher conversion rate (23% vs. 11%; p = 0.174) and complication rate (29% vs. 13%; p = 0.07). For 38 patients with symptoms exceeding 72 hours before admission, the conversion rate remained high after delayed surgery (30% vs. 17%; p = 0.454). In addition, delayed laparoscopic cholecystectomy prolonged the total hospital stay (11 days vs. 6 days; p < 0.001) and recuperation period (19 days vs. 12 days; p < 0.001). CONCLUSIONS: Initial conservative treatment followed by delayed interval surgery cannot reduce the morbidity and conversion rate of laparoscopic cholecystectomy for acute cholecystitis. Early operation within 72 hours of admission has both medical and socioeconomic benefits and is the preferred approach for patients managed by surgeons with adequate experience in laparoscopic cholecystectomy.     

Continuity of care experience of residents in an academic vascular department: Are trainees learning complete surgical care?

BACKGROUND: It is widely accepted that exemplary surgical care involves a surgeon's involvement in the preoperative, perioperative, and postoperative periods. In an era of ever-expanding therapeutic modalities available to the vascular surgeon, it is important that trainees gain experience in preoperative decision-making and how this affects a patient's operative and postoperative course. The purpose of this study was to define the current experience of residents on a vascular surgery service regarding the continuity of care they are able to provide for patients and the factors affecting this experience. METHODS: This prospective cohort study was approved by the Institutional Review Board and conducted at the University of British Columbia during January 2005. All patients who underwent a vascular procedure at either of the two teaching hospitals were included. In addition to type of case (emergent, outpatient, inpatient), resident demographic data and involvement in each patient's care (preoperative assessment, postoperative daily assessment, and follow-up clinic assessment) were recorded. Categoric data were analyzed with the chi2 test. RESULTS: The study included 159 cases, of which 65% were elective same-day admission patients, 20% were elective previously admitted patients; and 15% were emergent. The overall rate of preoperative assessment was 67%, involvement in the decision to operate, 17%; postoperative assessment on the ward, 79%; and patient follow-up in clinic, 3%. The rate of complete in-hospital continuity of care (assessing patient pre-op and post-op) was 57%. Emergent cases were associated with a significantly higher rate of preoperative assessment (92% vs 63%, P < .05). For elective cases admitted before the day of surgery compared with same-day admission patients, the rates of preoperative assessment (78% vs 58%, P < .05) and involvement in the decision to operate (16% vs 4%, P < .05) were significantly higher. CONCLUSIONS: The continuity-of-care experiences of vascular trainees are suboptimal. This is especially true for postoperative clinic assessment. Same-day admission surgery accounted for most of the cases and was associated with the poorest continuity of care. To provide complete surgical training in an era of changing therapeutic modalities and same-day admission surgery, vascular programs must be creative in structuring training to include adequate ambulatory experience.     

Comparative retrospective study of surgical treatment of spontaneous pneumothorax

Background: Since May 1992 we have used video-assisted thoracic surgery (VATS) for the treatment of the spontaneous pneumothorax. In this study we review the results obtained with this technique and we compare them with those obtained by conventional surgery (1976–1992). Methods: 110 patients (98 males and 12 females, age 15–83 years) were operated by VATS, and 627 patients (567 males and 60 females, age 14–89 years) by conventional surgery. The surgical technique and the complications are compared. No one died. Results: Although the number of complications was greater in the first group than in the second one (29.5% vs 15.1%), this is attributed to the lack of experience among surgeons in the first cases; which complications nearly disappeared in the last 60 patients. Less pain, better recovery, and shorter hospital stay resulted. Conclusions: For us VATS is the ideal technique with which to treat spontaneous pneumothorax.     

Computed tomography before transfer to a level I pediatric trauma center risks duplication with associated increased radiation exposure

Introduction

Community hospitals commonly obtain computed tomographic (CT) imaging of pediatric trauma patients before triaging to a level I pediatric trauma center (PTC). This practice potentially increases radiation exposure when imaging must be duplicated after transfer.

Methods

A retrospective review of our level 1 PTC registry from January 1, 2004, to December 31, 2006, was conducted. Level I and II trauma patients were grouped based on whether they had undergone outside CT examination (head and/or abdomen) at a referring hospital (group 1) or received initial CT examination at our institution (group 2). Subgroups were analyzed based on whether duplicate CT examination was required at our PTC (Fischer's Exact test).

Results

A duplicate CT scan (within 4 hours of transfer) was required in 91% (30/33) of group 1 transfer patients, whereas no group 2 patient required a duplicate scan (0/55; P < .0001). There was no significant difference within the groups for weight, age, or intensive care unit length of stay.

Conclusion

A significant number of pediatric trauma patients who receive CT scans at referring hospitals before transfer to our level I PTC require duplicate scans of the same anatomical field(s) after transfer, exposing them to increase potential clinical risk and cost.     

Impact of clinical pathways on hospital costs and early outcome after major vascular surgery

Purpose: The purpose of this study was to determine whether major vascular surgery could be performed safely and with significant hospital cost savings by decreasing length of stay and implementation of vascular clinical pathways.Methods: Morbidity, mortality, readmission rates, same-day admissions, length of stay, and hospital costs were compared between patients who were electively admitted between September 1, 1992, and August 30, 1993 (group 1), and January 1 to December 31, 1994 (group 2), for extracranial, infrarenal abdominal aortic, and lower extremity arterial surgery. For group 2 patients, vascular critical pathways were instituted, a dedicated vascular ward was established, and outpatient preoperative arteriography and anesthesiology-cardiology evaluations were performed. Length-of-stay goals were 1 day for extracranial, 5 days for aortic, and 2 to 5 days for lower extremity surgery. Emergency admissions, inpatients referred for vascular surgery, patients transferred from other hospitals, and patients who required prolonged preoperative treatment were excluded.Results: With this strategy same-day admissions were significantly increased (80% [145/177] vs 6.2% [9/145]) (p < 0.0001), and average length of stay was significantly decreased (3.8 vs 8.8 days) (p < 0.0001) in group 2 versus group 1, respectively. There were no significant differences between group 1 and group 2 in terms of overall mortality rate (2.1% [3/145] vs 2.3% [4/177]), cardiac (3.4% [5/145] vs 4.0% [7/177]), pulmonary (4.1% [6/145] vs 1.7% [3/177]), or neurologic (1.4% [2/145] vs 0% [0/177]) complications, or readmission within 30 days (11.3% [16/142] vs 9.2% [16/173]) (p > 0.05). There were also no differences in morbidity or mortality rates when each type of surgery was compared. Annual hospital cost savings totalled $1,267,445.Conclusion: Same-day admission and early hospital discharge for patients undergoing elective major vascular surgery can result in significant hospital cost savings without apparent increase in morbidity or mortality rates. (J VASC SURG 1995;22:649-60.)     

Fast-track video-assisted bullectomy and pleurectomy for pneumothorax: initial experience and description of technique

Objective: Pleurectomy ± bullectomy by video-assisted thoracoscopic surgery (VATS) is an established surgical procedure for pneumothorax. Early ambulation and discharge should be a reasonable goal. This study explores the feasibility of day-case surgery and identifies the obstacles requiring further work to facilitate day-case pneumothorax surgery. Methods: Between June 2007 and May 2008, 16 consecutive patients underwent video-assisted thoracoscopic surgery bullectomy ± pleurectomy (under the care of a single surgeon) with immediate connection to an ambulatory drainage system in the theatre following surgery. Analgesia comprised temporary paravertebral with early conversion to oral opiate ± paracetamol. There were 13 males (81%), average age 23 (range: 17–29) years, and three females (19%), average age 35 (range: 22–46) years. Twelve patients (75%) had left-sided disease, of which nine (56%) underwent elective surgery. All patients had previously suffered at least one primary spontaneous pneumothorax. Patients with probable secondary pneumothorax were excluded from the study. Length of stay (LOS) was compared with a control group of patients conventionally treated prior to the study. Results: In 13 patients (81%), early discharge was achieved 1 (range: 1–2 days) day post-op, whilst connected to an ambulatory drainage system. In three patients, early discharge was not achieved. One of these patients had the chest drain removed prematurely and remained an inpatient for 3 days with aspiration and observation for a small pneumothorax. The two remaining patients required extended inpatient admissions due to postoperative non-surgical complications. In the 13 patients discharged immediately, the time to drain removal (in clinic) was electively 7 days (range: 2–11 days). Two patients required re-admission: one for contralateral spontaneous pneumothorax and another for an ipsilateral basal pneumothorax treated with a drain. Conclusion: We have shown early discharge with ongoing ambulatory drainage following VATS pleurectomy ± bullectomy in patients with primary pneumothorax to be feasible with paravertebral in the theatre and rapid conversion to oral analgesia. Patients managed intercostal drains at home. Limiting factors such as postoperative nausea and pain control usually can be sufficiently managed in the outpatient. Shorter stays may have a beneficial financial result. Long-term follow-up and a quantification of the patients experience is warranted.     

The efficacy and timing of operative intervention for spontaneous pneumothorax

To reassess the role and timing of operative intervention for spontaneous pneumothorax, 119 patients were retrospectively reviewed to compare recurrences, complications, and hospital stay between a nonoperative group (Group 1) and an operative group (Group 2). Total hospital days were greater in Group 2, but excluding the length of preoperative stay, the number of hospital days were similar in both groups. Group 1 patients more than 40 years old had a longer postoperative hospitalization, but not a higher rate of complication. Overall, morbidity was not different between the two groups, and there were no immediate or perioperative deaths in either group. There were no recurrences in Group 2. At least 11 of the 49 patients in Group 1 had a recurrence (p = .012). Considering the excellent results achieved with operative pleurodesis and the total hospital days accrued with nonoperative therapy, operative pleurodesis should be considered if an active leak persists more than three days after the initial episode of spontaneous pneumothorax or at the time of the first recurrence in the hospitalized patient.     

Postoperative effects of low-dose intrathecal morphine in coronary artery bypass surgery

BACKGROUND: Intrathecal morphine has been used in hopes of providing long-lasting postoperative analgesia in patients after cardiac surgery. The aim of this study was to evaluate the effects of 7 micro/kg intrathecal morphine administration in coronary bypass surgery in the postoperative period. METHODS: We conducted a prospective, randomized, blinded, and controlled study. Twenty-three patients, who underwent primary elective coronary bypass surgery, were randomly allocated to receive morphine 7 micro/kg intrathecally, before the induction of general anesthesia (Group M, n = 12) or no intrathecal injection (Group C, n = 11). Pain scores, determined by visual analogue scale (VAS), were recorded immediately after extubation upon admission to the intensive care unit (ICU), at the 2nd, 4th, 6th, and 18th hour after extubation. Pethidine was administered if the patient's VAS > or = 4 and consumption was recorded. Extubation time and ICU length of stay were also recorded. RESULTS: VAS scores were lower in the Group M at each measured time than the control group (p = 0.016, 0.023, 0.004, 0.0001, and 0.001, respectively). According to the VAS scores, pethidine requirement was lower in the Group M than the control (p = 0.001). Extubation time (3.58 +/- 1.57 vs. 4.86 +/- 1.38 hours, p = 0.045) and ICU length of stay (16.25 +/- 2.70 vs. 19.30 +/- 2.45 hours, p = 0.014) were also significantly shorter in the Group M than the control group. No significant complications were seen in this group of patients. CONCLUSIONS: Intrathecal morphine provided effective analgesia, earlier tracheal extubation and less ICU length stay after on-pump coronary bypass surgery. The influence on ICU length of stay requires further evaluations.