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British Journal of Anaesthesia, 2003, Vol. 90, No. 3 300-303
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Intrathecal morphine and clonidine for coronary artery bypass grafting

P. Lena1, N. Balarac1, J. J. Arnulf1, J. Teboul1 and F. Bonnet*,2

1 Institut Arnault Tzanck, Saint Laurent du Var, Nice, France. 2 Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France

Corresponding author: Department of Anaesthesia and Intensive Care, Hôpital Tenon, Rue de la Chine, F-75970 Paris Cedex 20, France. E-mail: francis.bonnet@tnn.ap-hop-paris.fr

Background. After cardiac surgery adequate postoperative analgesia is necessary. We assessed analgesia using intrathecal morphine and clonidine.

Methods. In a double-blind randomized study, 45 patients having coronary artery bypass graft surgery were allocated randomly to receive i.v. patient-controlled analgesia (PCA) morphine (bolus, 1 mg; lock-out interval, 7 min) (control group), either alone or combined with intrathecal morphine 4 µg kg–1 or with both intrathecal morphine 4 µg kg–1 and clonidine 1 µg kg–1. Intrathecal injections were performed before the induction of general anaesthesia. Pain was measured after surgery using a visual analogue scale (VAS). We recorded i.v. PCA morphine consumption during the 24 h after operation.

Results. Morphine dosage [median (25th–75th percentiles)] was less in the first 24 h in the patients who were given intrathecal morphine + clonidine [7 (0–37) mg] than in other patients [40.5 (15–61.5) mg in the intrathecal morphine group and 37 (30.5–51) mg in the i.v. morphine group]. VAS scores were lower after intrathecal morphine + clonidine compared with the control group. Time to extubation was less after intrathecal morphine + clonidine compared with the i.v. morphine group [225 (195–330) vs 330 (300–360) min, P<0.05].

Conclusion. Intrathecal morphine and clonidine provide effective analgesia after coronary artery bypass graft surgery and allow earlier extubation.

Br J Anaesth 2003; 90: 300–3


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