Preoperative lumbar epidural morphine improves postoperative analgesia and ventilatory function after transsternal thymectomy in patients with myasthenia gravis. Crit Care Med 1991 Dec;19(12):1474-9
Date
12/01/1991Pubmed ID
1959365DOI
10.1097/00003246-199112000-00006Scopus ID
2-s2.0-0026340755 (requires institutional sign-in at Scopus site) 37 CitationsAbstract
OBJECTIVE: To test the hypothesis that preoperative lumbar epidural morphine improves postoperative pain control and ventilatory function after transsternal thymectomy in patients with myasthenia gravis.
DESIGN: The study design was randomized, placebo-controlled, and double-blind.
SETTING: After surgery, all patients were admitted to the Neuroscience Critical Care Unit for evaluation and treatment.
PATIENTS: All patients with myasthenia gravis who presented to the hospital for thymectomy were asked to participate in the study. Twenty patients were randomized to either the placebo or epidural morphine groups.
INTERVENTIONS: Patients received either epidural morphine (7 mg in 14 mL of sterile saline) or saline (14 mL) before induction of anesthesia. Supplemental iv opioids were administered intraoperatively, with need determined by the anesthesiologist.
MAIN OUTCOME MEASURES: The main outcome measures were indicators of postoperative pain (e.g., Visual Analog Pain Score, requirement for supplemental opioid administration, respiratory rate) and ventilatory function (e.g., forced vital capacity, negative inspiratory pressure).
RESULTS: Immediately after surgery, the Visual Analog Pain Score in the placebo group was twice as high as the score in the epidural morphine group (placebo 7.0 +/- 1.3; epidural morphine 3.5 +/- 1.2, p less than or equal to .05). During the first eight postoperative hours, the placebo group required more opioids (0.22 +/- 0.03 vs. 0.12 +/- 0.04 mg/kg morphine equivalents, p less than or equal to .06) than the epidural morphine group. Later, both groups received similar amounts of opioids. Patients receiving epidural morphine had better initial recovery of forced vital capacity (at 8 hrs: 55 +/- 6% [epidural morphine] vs. 34 +/- 5% [placebo] of preoperative value, p less than or equal to .05). Respiratory rate was lower for the first 12 postoperative hours in the epidural morphine group, without a difference in PaCO2. There was no difference between groups for the duration of postoperative intubation or ventilation.
CONCLUSIONS: Preoperative lumbar epidural morphine facilitates postoperative analgesia and improves initial postoperative ventilatory performance.
Author List
Kirsch JR, Diringer MN, Borel CO, Hanley DF, Merritt WT, Bulkley GBMESH terms used to index this publication - Major topics in bold
AdultAnalgesia, Epidural
Double-Blind Method
Drug Therapy, Combination
Female
Humans
Injections, Intravenous
Male
Monitoring, Physiologic
Morphine
Myasthenia Gravis
Narcotics
Pain Measurement
Pain, Postoperative
Preanesthetic Medication
Prospective Studies
Respiration
Respiration, Artificial
Thymectomy
Time Factors
Treatment Outcome
Vital Capacity