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Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery

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Abstract

We conducted a study to compare the effectiveness of patientcontrolled analgesia (PCA) technique to conventional analgesic therapy (CAT) after coronary artery bypass graft (CABG). The PCA group received hydromorphone 0.1 mg · hr−1 basal infusion and bolus doses of 0.2 mg Q 5 min (maximum 1.2 mg · hr−1) while the CAT group received morphine 2.5 mg iv Q 30 min prn until extubation followed by prn meperidine 1 mg · kg−1 im Q4 hr or acetaminophen 325 mg with codeine 30 mg po (1 or 2 tablets) when oral intake was possible. The degree of pain was assessed using a Visual Analogue Scale (VAS) starting after extubation and every 6–8 hr for the next 60 hr. Holter monitoring was initiated one hour after patient arrival in the Intensive Care Unit (ICU) and continued for 72 hr. Other measured variables were pulmonary function, sedation, side effects and total opioid requirements. Results show that the day-to-day VAS pain score decreased in the PCA group (P < 0.001) while it remained unchanged in CAT patients. The PCA patients had lower VAS pain scores at extubation (P < 0.05). During the third postoperative day, the PCA group had a lower VAS pain score, a lower incidence of severe pain defined as a score > 5 on the VAS scale, and a reduced incidence of myocardial ischaemia (P < 0.01). However, there was no difference in the duration, severity, area under the curve (AUC), or heart rate during ischaemic events. Postoperative pulmonary function was abnormal in both groups (NS) with minimal recovery by the fourth day. Opioid requirements, incidence of side effects and the degree of sedation were similar. We conclude that the PCA technique for analgesia provided slightly better results. The finding of a reduced incidence of myocardial ischaemia in the PCA group warrants further clinical investigation.

Résumé

Nous avons effectué une étude comparative sur l’efficacité de l’analgésie contrôlée par le patient (PCA) par rapport au traitement analgésique conventionnel (CAT) chez des patients subissant une chirurgie de revascularisation myocardique. Après randomisation, le groupe PCA (n = 30) recevait une perfusion continue d’hydromorphone (0.1 mg · hr−1) avec des bolus de 0.2 mg Q 5 min (maximum 1.2 mg · hr−1), alors que le groupe CAT (n = 30) recevait morphine 2.5 mg iv Q 30 min prn jusqu’à l’extubation, suivie par mépéridine 1 mg · kg−1 im Q 4 hr prn ou acétaminophène 325 mg avec codéine 30 mg po (1–2 comprimés) lorsque le patient pouvait s’alimenter. La perception de douleur fut évaluée à l’aide d’une échelle visuelle analogique (VAS) lorsque le patient fut extubé et à toutes les 6–8 hr pendant 60 hr. Un monitorage Holter de 72 hr fut débuté 1 hr après l’arrivée du patient aux soins intensifs. L’étude a aussi évalué les changements dans la fonction pulmonaire, la sédation, les effets secondaires et la quantité d’opiacés requise. Nos résultats démontrent que le degré de sévérité de la douleur a diminué significativement d’une journée à l’autre dans le groupe PCA (P > 0.001) comparativement au groupe CAT A l’extubation, les patients PCA avaient moins de douleur (P < 0.05). Au troisième jour postopératoire, le groupe PCA avail moins de douleur (P < 0.05), aucune incidence de douleur sévère (P < 0.01) et une incidence diminuée d’ischémie myocardique (P < 0.01). Toutefois, il n’y avail pas de différence dans la durée, l’intensité, la surface sous la courbe (AUC) et la fréquence cardiaque pendant les épisodes d’ischémie myocardique. La fonction pulmonaire postopératoire était anormale dans les deux groupes (P = NS) avec très peu de récupération après quatre jours. Les besoins en opiacés, l’incidence des effets secondaires et le degré de sédation étaient similaires. Nous concluons que la technique de PCA procure une analgésie légèrement supérieure. Le fait qu’il y avail une diminution dans l’incidence d’ischémie myocardique dans le groupe PCA nécessite d’autres investigations cliniques.

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Author information

Correspondence to Norman R. Searle.

Additional information

This study was partly supported by a research grant from Knoll Pharmaceutical.

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Searle, N.R., Roy, M., Bergeron, G. et al. Hydromorphone patient-controlled analgesia (PCA) after coronary artery bypass surgery. Can J Anaesth 41, 198–205 (1994). https://doi.org/10.1007/BF03009831

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Key words

  • Analgesia: Patient-controlled analgesia
  • Analgesic: hydromorphone
  • Anaesthesia: cardiac, myocardial ischaemia