The effects of intrathecal morphine on patients undergoing minimally invasive direct coronary artery bypass surgery

OBJECTIVE: To evaluate the effects of intrathecal morphine (ITM) on the perioperative use of opiates and the fast-track pathway in patients undergoing minimally invasive direct coronary artery bypass grafting (MIDCAB). DESIGN: Retrospective cohort study. SETTINGS: University teaching hospital. PARTICIPANTS: Twenty-two elective consecutive patients who underwent MIDCAB surgery. INTERVENTIONS: Eleven patients received an intrathecal injection of morphine, 7 microg/kg (ITM group, n=11), and the control group (n=11) received standard anesthesia care. MEASUREMENTS AND MAIN RESULTS: The intraoperative dose of fentanyl was 0.55+/-0.2 mg in the ITM group and 1.1+/-0.2 mg in the control group (p<0.0001). Four patients in the ITM group and none in the control group were extubated in the operating room. Extubation time was 3.2+/-4.7 hours in the ITM group and 6.3+/-3.4 hours in the control group (p=0.016). Morphine requirements in 24 hours after surgery were 2.0+/-3.5 mg in the ITM and 16.1+/-4.8 mg in the control group (p<0.0001). There were no differences in ischemic time, intraoperative fluid requirements, postoperative blood loss, and duration of surgical procedure. Hospital length of stay was shorter in the ITM group compared with the control group (3.9+/-1.7 days v 4.9+/-1.4 days, respectively, p=0.047). CONCLUSIONS: ITM has to be considered in MIDCAB surgery as an effective component of the perioperative analgesia. The safety and effects of ITM in the patients recovery after MIDCAB surgery should be evaluated in further prospective studies.