Fast-track coronary artery bypass grafting surgery under general anesthesia with remifentanil and spinal analgesia with morphine and clonidine

Objective: Effective postoperative analgesia is a critical part of fast-track cardiac surgery. This study compared the postoperative analgesic effect of fast-track anesthesia with remifentanil and spinal morphine and clonidine with that of sufentanil anesthesia followed by patient-controlled administration of intravenous morphine. Design: Prospective, blinded, randomized study. Setting: Single private institution. Participants: Forty patients selected for coronary artery bypass graft surgery allocated randomly into 2 groups. Interventions: General anesthesia was performed with etomidate, isoflurane, cisatracurium, and either remifentanil (0.10-0.25 mug/kg/min) or sufentanil (up to 3.5 mug/kg). In the remifentanil group, patients received spinal morphine (4 mug/kg) and clonidine (1 mug/kg) before induction. Postoperatively, patients in both groups were connected to an intravenous patient-controlled analgesia (PCA) morphine pump that delivered a 1-g bolus with a 7-minute lockout interval. Measurements and Main Results: Patients were evaluated for pain on a visual analog scale (VAS), at rest and on deep breathing, and for intravenous PCA morphine consumption during 24 hours. The intravenous PCA morphine 24-hour cumulative dose was lower in the fast-track than in the control group (15.8 +/- 12.6 v 32.7 +/- 22.3 mg, p < 0.05). Before extubation, VAS scores were higher in the fast-track group, but after they were lower both at rest and during deep breathing. Extubation delay was shorter in the fast-track group (156.5 +/- 46.1 v 272 +/- 116.4 minutes, p < 0.05). Conclusion: The combination of anesthesia with remifentanil and spinal analgesia with morphine and clonidine produces effective analgesia after coronary artery surgery and a rapid extubation time. (C) 2005 Elsevier Inc. All rights reserved.