PMID- 33564993
OWN - NLM
STAT- MEDLINE
DCOM- 20210614
LR  - 20230829
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 68
IP  - 6
DP  - 2021 Jun
TI  - Postoperative hemodynamics after high spinal block with or without intrathecal 
      morphine in cardiac surgical patients: a randomized-controlled trial.
PG  - 825-834
LID - 10.1007/s12630-021-01937-z [doi]
AB  - PURPOSE: There is some evidence for the use of intrathecal morphine as a means to 
      provide prolonged analgesia in selective cardiac surgical patients; however, the 
      hemodynamic effects of intrathecal morphine are not well defined. This study was 
      designed to study the effect of intrathecal morphine on hemodynamic parameters in 
      cardiac surgery patients. METHODS: In a prospective, double-blind study, 100 
      adult cardiac surgical patients were randomized to receive either intrathecal 40 
      mg of 0.5% hyperbaric bupivacaine alone (intrathecal bupivacaine [ITB] group, n = 
      50) or intrathecal 250 microg of morphine added to 40 mg of 0.5% bupivacaine 
      (intrathecal bupivacaine and morphine [ITBM] group, n = 50). Hemodynamic data, 
      pain scores, rescue analgesic use, spirometry, and vasopressor use were recorded 
      every four hours after surgery for 48 hr. The primary outcome was the incidence 
      of vasoplegia in each group, which was defined as a cardiac index > 2.2 
      L.min(-1).m(-2) with the requirement of vasopressors to maintain the mean 
      arterial pressure > 60 mmHg with the hemodynamic episode lasting > four hours. 
      RESULTS: Eighty-seven patients were analyzed (ITB group, n = 42, and ITBM group, 
      n =45). The incidence of vasoplegia was higher in the ITBM group than in the ITB 
      group [14 (31%) vs 5 (12%), respectively; relative risk, 2.6; 95% confidence 
      interval [CI], 1.0 to 6.6; P = 0.04]. The mean (standard deviation [SD]) duration 
      of vasoplegia was significantly longer in the ITBM group than in the ITB group 
      [8.9 (3.0) hr vs 4.3 (0.4) hr, respectively; difference in means, 4.6; 95% CI, 
      3.7 to 5.5; P < 0.001]. CONCLUSION: Intrathecal morphine added to bupivacaine for 
      high spinal anesthesia increases the incidence and duration of vasoplegia in 
      cardiac surgery patients. TRIAL REGISTRATION: www.clinicaltrials.gov 
      (NCT02825056); registered 19 June 2016.
FAU - Bhat, Imran
AU  - Bhat I
AD  - Department of Anaesthesiology and Intensive Care, Post Graduate Institute of 
      Medical Education and Research, Chandigarh, India.
FAU - Arya, Virendra K
AU  - Arya VK
AUID- ORCID: 0000-0002-6291-0187
AD  - Department of Anaesthesiology and Intensive Care, Post Graduate Institute of 
      Medical Education and Research, Chandigarh, India. aryavk_99@yahoo.com.
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College 
      of Medicine, University of Manitoba, St. Boniface Hosptial, Winnipeg, MB, Canada. 
      aryavk_99@yahoo.com.
FAU - Mandal, Banashree
AU  - Mandal B
AD  - Department of Anaesthesiology and Intensive Care, Post Graduate Institute of 
      Medical Education and Research, Chandigarh, India.
FAU - Jayant, Aveek
AU  - Jayant A
AD  - Department of Anaesthesiology and Critical Care Medicine, Amrita Institute of 
      Medical Sciences, Kochi, India.
FAU - Dutta, Vikas
AU  - Dutta V
AD  - Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College 
      of Medicine, University of Manitoba, St. Boniface Hosptial, Winnipeg, MB, Canada.
FAU - Rana, Sandeep Singh
AU  - Rana SS
AD  - Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of 
      Medical Education and Research, Chandigarh, India.
LA  - eng
SI  - ClinicalTrials.gov/NCT02825056
PT  - Journal Article
PT  - Randomized Controlled Trial
TT  - L'hemodynamie postoperatoire apres un bloc rachidien haut avec ou sans morphine 
      intrathecale chez les patients de chirurgie cardiaque : une etude randomisee 
      controlee.
DEP - 20210209
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Analgesics, Opioid)
RN  - 0 (Anesthetics, Local)
RN  - 76I7G6D29C (Morphine)
RN  - Y8335394RO (Bupivacaine)
SB  - IM
MH  - Adult
MH  - Analgesics, Opioid/therapeutic use
MH  - *Anesthesia, Spinal
MH  - Anesthetics, Local/therapeutic use
MH  - Bupivacaine
MH  - *Cardiac Surgical Procedures
MH  - Double-Blind Method
MH  - Hemodynamics
MH  - Humans
MH  - Injections, Spinal
MH  - Morphine/therapeutic use
MH  - Pain, Postoperative/drug therapy/epidemiology
MH  - Prospective Studies
OTO - NOTNLM
OT  - cardiac surgery
OT  - high spinal
OT  - neuraxial anessthesia
OT  - spinal anesthesia
EDAT- 2021/02/11 06:00
MHDA- 2021/06/16 06:00
CRDT- 2021/02/10 05:59
PHST- 2020/05/18 00:00 [received]
PHST- 2020/11/18 00:00 [accepted]
PHST- 2020/11/14 00:00 [revised]
PHST- 2021/02/11 06:00 [pubmed]
PHST- 2021/06/16 06:00 [medline]
PHST- 2021/02/10 05:59 [entrez]
AID - 10.1007/s12630-021-01937-z [pii]
AID - 10.1007/s12630-021-01937-z [doi]
PST - ppublish
SO  - Can J Anaesth. 2021 Jun;68(6):825-834. doi: 10.1007/s12630-021-01937-z. Epub 2021 
      Feb 9.