• Pierre Lena, Norbert Balarac, Jean Jacques Arnulf, Jean Yves Bigeon, Michel Tapia, and Francis Bonnet.
• Institut Arnault Tzanck, Saint-Laurent du Var, France.
• J. Cardiothorac. Vasc. Anesth. 2005 Feb 1;19(1):49-53.

ObjectiveEffective postoperative analgesia is a critical part of fast-track cardiac surgery. This study compared the postoperative analgesic effect of fast-track anesthesia with remifentanil and spinal morphine and clonidine with that of sufentanil anesthesia followed by patient-controlled administration of intravenous morphine.DesignProspective, blinded, randomized study.SettingSingle private institution.ParticipantsForty patients selected for coronary artery bypass graft surgery allocated randomly into 2 groups.InterventionsGeneral anesthesia was performed with etomidate, isoflurane, cisatracurium, and either remifentanil (0.10-0.25 microg/kg/min) or sufentanil (up to 3.5 microg/kg). In the remifentanil group, patients received spinal morphine (4 microg/kg) and clonidine (1 microg/kg) before induction. Postoperatively, patients in both groups were connected to an intravenous patient-controlled analgesia (PCA) morphine pump that delivered a 1-g bolus with a 7-minute lockout interval.Measurements And Main ResultsPatients were evaluated for pain on a visual analog scale (VAS), at rest and on deep breathing, and for intravenous PCA morphine consumption during 24 hours. The intravenous PCA morphine 24-hour cumulative dose was lower in the fast-track than in the control group (15.8+/-12.6 v 32.7+/-22.3 mg, p<0.05). Before extubation, VAS scores were higher in the fast-track group, but after they were lower both at rest and during deep breathing. Extubation delay was shorter in the fast-track group (156.5+/-46.1 v 272+/-116.4 minutes, p<0.05).ConclusionThe combination of anesthesia with remifentanil and spinal analgesia with morphine and clonidine produces effective analgesia after coronary artery surgery and a rapid extubation time.

26 keywords...

hide…