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The efficacy of intravenous patient-controlled remifentanil versus morphine anesthesia after coronary artery surgery.
J Cardiothorac Vasc Anesth. 2009 Apr; 23(2):170-4.JC

Abstract

OBJECTIVE

To compare the effect of remifentanil and morphine after coronary artery surgery in a patient-controlled analgesia (PCA) protocol.

DESIGN

A prospective, randomized, double-blind clinical study.

SETTING

Single institution, university hospital.

PARTICIPANT

Sixty cardiac surgical patients undergoing primary coronary artery bypass graft (CABG) surgery.

INTERVENTIONS

After the operation, patients were allocated to 1 of 2 groups. In the first group (group R, n = 30), the following intravenous PCA protocol was programmed: remifentanil infusion, 0.05 microg/kg/min; bolus, 0.25 microg/kg; and lockout time, 5 minutes. In the second group (group M, n = 30), the intravenous PCA protocol was as follows: morphine infusion, 0.3 mg/h; bolus, 1 mg; and lockout time, 5 minutes. In addition to intravenous opioids, paracetamol was administered during the study. In both groups, tramadol was added to the regimen after PCA had been terminated at 24 hours after surgery. In addition to tramadol and paracetamol, 10 mg of morphine sulfate was administered if the numeric rating scale (NRS) score for pain was 3 or more after the first postoperative day. Pain was assessed with an NRS in each patient at rest, while coughing, and during movement for 72 hours. Sedation levels were measured with the Ramsay sedation scale. Overall effectiveness of pain relief was evaluated with a 4-stage scale ("very good," "good," "moderate," or "bad").

MEASUREMENTS AND RESULTS

During coughing, the NRS values were statistically significantly lower in group R than they were in group M at 12 and 24 hours after surgery (median 1 vs 3 at 12 hours and 2 v 3.5 at 24 hours) (p < 0.05). On movement, NRS values were statistically significantly lower in group R than they were in group M at 12 hours after surgery (median 1 v 2.5) (p < 0.05). After the first 24 hours, the requirement for additional analgesia was similar in both groups. The overall effectiveness of pain relief was rated "very good" or "good"' in 87% of patients in group R and in 72% of patients in group M (p > .05).

CONCLUSION

There was no difference in patient satisfaction between the 2 groups. On the basis of the reduction of pain scores (with cough and movement) at 1 or 2 postoperative time points, PCA-remifentanil infusion is a better analgesic technique; overall, both PCA techniques provided for effective pain scores (<3). In patients in whom PCA morphine is contraindicated after CABG surgery, PCA remifentanil is a safe alternative.

Authors+Show Affiliations

Department of Anesthesiology, Baskent University Adana Teaching and Medical Research Center, Adana, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18834819

Citation

Baltali, Sevim, et al. "The Efficacy of Intravenous Patient-controlled Remifentanil Versus Morphine Anesthesia After Coronary Artery Surgery." Journal of Cardiothoracic and Vascular Anesthesia, vol. 23, no. 2, 2009, pp. 170-4.
Baltali S, Turkoz A, Bozdogan N, et al. The efficacy of intravenous patient-controlled remifentanil versus morphine anesthesia after coronary artery surgery. J Cardiothorac Vasc Anesth. 2009;23(2):170-4.
Baltali, S., Turkoz, A., Bozdogan, N., Demirturk, O. S., Baltali, M., Turkoz, R., & Arslan, G. (2009). The efficacy of intravenous patient-controlled remifentanil versus morphine anesthesia after coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia, 23(2), 170-4. https://doi.org/10.1053/j.jvca.2008.07.006
Baltali S, et al. The Efficacy of Intravenous Patient-controlled Remifentanil Versus Morphine Anesthesia After Coronary Artery Surgery. J Cardiothorac Vasc Anesth. 2009;23(2):170-4. PubMed PMID: 18834819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The efficacy of intravenous patient-controlled remifentanil versus morphine anesthesia after coronary artery surgery. AU - Baltali,Sevim, AU - Turkoz,Ayda, AU - Bozdogan,Nesrin, AU - Demirturk,Orhan Saim, AU - Baltali,Mehmet, AU - Turkoz,Riza, AU - Arslan,Gulnaz, Y1 - 2008/09/24/ PY - 2008/03/26/received PY - 2008/10/7/pubmed PY - 2009/7/16/medline PY - 2008/10/7/entrez SP - 170 EP - 4 JF - Journal of cardiothoracic and vascular anesthesia JO - J. Cardiothorac. Vasc. Anesth. VL - 23 IS - 2 N2 - OBJECTIVE: To compare the effect of remifentanil and morphine after coronary artery surgery in a patient-controlled analgesia (PCA) protocol. DESIGN: A prospective, randomized, double-blind clinical study. SETTING: Single institution, university hospital. PARTICIPANT: Sixty cardiac surgical patients undergoing primary coronary artery bypass graft (CABG) surgery. INTERVENTIONS: After the operation, patients were allocated to 1 of 2 groups. In the first group (group R, n = 30), the following intravenous PCA protocol was programmed: remifentanil infusion, 0.05 microg/kg/min; bolus, 0.25 microg/kg; and lockout time, 5 minutes. In the second group (group M, n = 30), the intravenous PCA protocol was as follows: morphine infusion, 0.3 mg/h; bolus, 1 mg; and lockout time, 5 minutes. In addition to intravenous opioids, paracetamol was administered during the study. In both groups, tramadol was added to the regimen after PCA had been terminated at 24 hours after surgery. In addition to tramadol and paracetamol, 10 mg of morphine sulfate was administered if the numeric rating scale (NRS) score for pain was 3 or more after the first postoperative day. Pain was assessed with an NRS in each patient at rest, while coughing, and during movement for 72 hours. Sedation levels were measured with the Ramsay sedation scale. Overall effectiveness of pain relief was evaluated with a 4-stage scale ("very good," "good," "moderate," or "bad"). MEASUREMENTS AND RESULTS: During coughing, the NRS values were statistically significantly lower in group R than they were in group M at 12 and 24 hours after surgery (median 1 vs 3 at 12 hours and 2 v 3.5 at 24 hours) (p < 0.05). On movement, NRS values were statistically significantly lower in group R than they were in group M at 12 hours after surgery (median 1 v 2.5) (p < 0.05). After the first 24 hours, the requirement for additional analgesia was similar in both groups. The overall effectiveness of pain relief was rated "very good" or "good"' in 87% of patients in group R and in 72% of patients in group M (p > .05). CONCLUSION: There was no difference in patient satisfaction between the 2 groups. On the basis of the reduction of pain scores (with cough and movement) at 1 or 2 postoperative time points, PCA-remifentanil infusion is a better analgesic technique; overall, both PCA techniques provided for effective pain scores (<3). In patients in whom PCA morphine is contraindicated after CABG surgery, PCA remifentanil is a safe alternative. SN - 1532-8422 UR - https://www.unboundmedicine.com/medline/citation/18834819/The_efficacy_of_intravenous_patient_controlled_remifentanil_versus_morphine_anesthesia_after_coronary_artery_surgery_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1053-0770(08)00218-8 DB - PRIME DP - Unbound Medicine ER -