Potential Beneficial Effects Of Intrathecal Opioids In Cardiac Surgical Patients

Background: Postoperative pain control plays an important role on prognosis of patients undergoing thoracic surgery. The length of stay in the intensive care units and hospital is correlated with the quality of pain management. We assessed the potential role of intrathecal opioid supplement for fast tracking cardiac surgery patients. Methods: This is a retrospective, chart review of 133 consecutive patients undergoing open-heart procedure at Buffalo VA Medical Center. They were studied with respect to time-to-extubation, the degree of pain relief, and postoperative parentral narcotic use. Sixty-four patients received supplemental intrathecal opioids and 69 patients received conventional opioid-based anesthesia. Postoperative visual analog pain scores and 24 h analgesic requirements were measured as indices of postoperative pain. Time to extubation, partial pressure of oxygen and carbon dioxide were measured as indices of respiratory function. Results: Patients receiving intrathecal opioids appeared to be more comfortable (VAS = 2 vs. 7) upon arrival at the surgical intensive care unit (SICU) and 24 h after surgery (VAS = 3 vs. 5). These patients also required less parentral morphine in the first 24 hours after surgery (11.4 ± 3.1-mg vs. 52.6 ± 6.2; p<0.05). The majority of patients receiving intrathecal opioids were extubated in the operating room following termination of surgery, suggesting a lower incidence of postoperative respiratory depression. This was associated with a lower need for reintubation that those receiving IV opioids. Conclusion: We believe that the addition of spinal opioids was beneficial in the early postoperative care of cardiac surgery patients with respect to pain management and ventilatory requirements.