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British Journal of Anaesthesia, 1988, Vol. 60, No. 6 639-644
© 1988 The Board of Management and Trustees of the British Journal of Anaesthesia

research-article

INTRATHECAL MORPHINE IN THE MANAGEMENT OF PAIN FOLLOWING CARDIAC SURGERY

A Comparison with Morphine I.v.

G. J. FITZPATRICK and D. C. MORIARTY

GERARD J. FITZPATRICK, M.B., F.F.A.R.C.S.I.; DENIS C. MORIARTY, M.B., F.F.A.R.C.S.I., F.F.A.R.C.S.; Department of Anaesthesia, Mater Misericordiae Hospital, Dublin, Ireland.

Forty-four patients undergoing coronary revascularization received either intrathecal morphine 1 mg (n = 15), intrathecal morphine 2 mg (n = 15), or i.v. morphine 30 mg (n = 14) after the induction of anaesthesia. Morphine 2.5 mg i.v. was given, as required, in the postoperative period and pain score, respiratory rate and PaC02 measured every 2 h. FVC, FEV1 and PEFR were measured before, and 24 h after, the induction of anaesthesia. Mean overall pain scores in both intrathecal groups were significantly lower than in the i.v. group (P < 0.01), but did not differ significantly between the intrathecal groups. Consumption of supplementary morphine was significantly lower in both intrathecal groups (P < 0.01). Mean PaCO2 was significantly higher in patients given intrathecal morphine 2 mg. This was significant at 12, 14 and 16 h after induction of anaesthesia. Respiratory rate did not differ significantly between the groups. Postoperative PEFR was significantly better in patients given intrathecal morphine (P < 0.01). These results suggest that intrathecal morphine provided better analgesia after cardiac surgery than did a conventional regimen. The lower dose (1 mg) was associated with less respiratory depression as assessed by PaC02 measurements.


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