PMID- 28830362
OWN - NLM
STAT- MEDLINE
DCOM- 20180504
LR  - 20201209
IS  - 1471-2253 (Electronic)
IS  - 1471-2253 (Linking)
VI  - 17
IP  - 1
DP  - 2017 Aug 22
TI  - Impact of intrathecal morphine analgesia on the incidence of pulmonary 
      complications after cardiac surgery: a single center propensity-matched cohort 
      study.
PG  - 109
LID - 10.1186/s12871-017-0398-z [doi]
LID - 109
AB  - BACKGROUND: Acute pain and systemic opioids may both negatively impact 
      respiratory function after cardiac surgery. This study analyzes the local 
      practice of using intrathecal morphine analgesia (ITMA) with minimal parenteral 
      opioid administration in cardiac surgery, specifically the impact on 
      postoperative pulmonary complications (PPCs). METHODS: Data from adult patients 
      who underwent elective cardiac surgery between January 2002, and December 2013 in 
      a single center were analyzed. Propensity scores estimating the likelihood of 
      receiving ITMA were used to match (1:1) patients with ITMA and patients with 
      intravenous analgesia (IVA). Primary outcome was PPCs, a composite endpoint 
      including pneumonia, adult respiratory distress syndrome, and any type of acute 
      respiratory failure. Secondary outcomes were in-hospital mortality, 
      cardiovascular complications, and length of stay in the intensive care unit (ICU) 
      and hospital. RESULTS: From a total of 1'543 patients, 920 were treated with ITMA 
      and 623 with IVA. No adverse event consequent to the spinal puncture was 
      reported. Propensity score matching created 557 balanced pairs. The occurrence of 
      PPCs in patients with ITMA was 8.1% vs. 12.8% in patients with IVA (odds ratio, 
      0.6; 95% CI, 0.40-0.89; p = 0.012). Fewer patients with ITMA had a prolonged stay 
      in the ICU (> 4 days; 16.5% vs. 21.2%, p = 0.047) or in the hospital (> 15 days; 
      25.5% vs. 31.8%. p = 0.024). In-hospital mortality and cardiovascular 
      complications did not differ significantly between the two groups. CONCLUSION: In 
      this study involving cardiac surgical patients, ITMA was safely applied and was 
      associated with fewer PPCs.
FAU - Ellenberger, Christoph
AU  - Ellenberger C
AD  - Department of Anesthesiology, Pharmacology and Intensive Care, University 
      Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, -1211, Geneva, CH, 
      Switzerland.
FAU - Sologashvili, Tornike
AU  - Sologashvili T
AD  - Division of Cardiovascular Surgery, University Hospital of Geneva, rue 
      Gabrielle-Perret Gentil, Geneva, 1211, Switzerland.
FAU - Bhaskaran, Krishnan
AU  - Bhaskaran K
AD  - London School of Hygiene and Tropical Medicine, London, UK.
FAU - Licker, Marc
AU  - Licker M
AUID- ORCID: 0000-0002-3691-4440
AD  - Department of Anesthesiology, Pharmacology and Intensive Care, University 
      Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, -1211, Geneva, CH, 
      Switzerland. marc-joseph.licker@hcuge.ch.
LA  - eng
PT  - Journal Article
DEP - 20170822
PL  - England
TA  - BMC Anesthesiol
JT  - BMC anesthesiology
JID - 100968535
RN  - 76I7G6D29C (Morphine)
SB  - IM
MH  - Administration, Intravenous/adverse effects
MH  - Aged
MH  - Cardiac Surgical Procedures/*adverse effects/mortality
MH  - Cohort Studies
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Injections, Spinal/adverse effects
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Morphine/administration & dosage/*adverse effects
MH  - Pneumonia/chemically induced/*epidemiology
MH  - Postoperative Complications/epidemiology
MH  - Respiratory Distress Syndrome/chemically induced/*epidemiology
MH  - Respiratory Insufficiency/chemically induced/*epidemiology
MH  - Switzerland/epidemiology
PMC - PMC5567923
OTO - NOTNLM
OT  - Opiates
OT  - Postoperative respiratory failure
OT  - Pulmonary complications
OT  - Spinal analgesia
COIS- ETHICS APPROVAL AND CONSENT TO PARTICIPATE: This study was approved by the Ethics 
      Committee of the University Hospital of Geneva (Registration N degrees  CER 14-080R), 
      with a waiver for informed consent in order to protect participant anonymity. 
      CONSENT FOR PUBLICATION: Not applicable. No individual patient data will be 
      reported. COMPETING INTERESTS: The authors declare that they have no competing 
      interests. PUBLISHER'S NOTE: Springer Nature remains neutral with regard to 
      jurisdictional claims in published maps and institutional affiliations.
EDAT- 2017/08/24 06:00
MHDA- 2018/05/05 06:00
PMCR- 2017/08/22
CRDT- 2017/08/24 06:00
PHST- 2017/04/27 00:00 [received]
PHST- 2017/08/10 00:00 [accepted]
PHST- 2017/08/24 06:00 [entrez]
PHST- 2017/08/24 06:00 [pubmed]
PHST- 2018/05/05 06:00 [medline]
PHST- 2017/08/22 00:00 [pmc-release]
AID - 10.1186/s12871-017-0398-z [pii]
AID - 398 [pii]
AID - 10.1186/s12871-017-0398-z [doi]
PST - epublish
SO  - BMC Anesthesiol. 2017 Aug 22;17(1):109. doi: 10.1186/s12871-017-0398-z.