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The Effect of Combined Intrathecal Morphine and Clonidine on Stress Response, Extubation Time and Postoperative Analgesia after Cardiac Surgery

Mona Mohamed Mogahed, Jehan Mohammad Ezzat Hamed and Mohamed Shafik Elkahwagy

Background: Pain is a major complication after cardiac surgery, if it is poorly controlled, it will lead to more complication as respiratory depression, myocardial ischemia, delayed extubation, and more ICU stay, with the more analgesic consumption and patients suffering. Intrathecal morphine produces intense and prolonged analgesia and can be useful adjunct for controlling postoperative pain and facilitating early extubation after cardiac surgery. The addition of intrathecal clonidine to morphine allows the dose of intrathecal morphine to be reduced and reduces the risk of respiratory depression while maintaining good analgesia and allows early extubation. This randomized controlled study was carried out on 40 patients undergoing open cardiac surgery and was divided into two groups; group (I): is the control group (n=40) and group (II): is the morphine clonidine group (n=40), patients received intrathecal morphine 4 mcg/kg and clonidine 1 mic/kg. The aim of this study was to evaluate the effects of combined intrathecal morphine and clonidine on stress response, time of extubation, and postoperative analgesia after cardiac surgery. The results of our study revealed that, there was no statistical significant changes in CVP (central venous pressure), Sao2 (Oxygen saturation) and lactate level in both group, but there was a decrease in HR after induction and before bypass in the intrathecal morphine clonidine group compared with the control one, also there was a significant reduction in MAP after induction, before bypass and after bypass in morphine clonidine group vs. control group. Cortisol level was decreased after sternotomy, after ICU admission and after extubation in the morphine group vs. control group. Time to extubation, vas, and morphine consumption in 24 h were all decreased in the morphine group compared with the control one, with no significant differences in post-operative complication in both studied groups.
Conclusion: In patients with well-preserved ventricular and respiratory function scheduled for fast-track cardiac surgery, the use of combined intrathecal morphine 250 μg and clonidine provides good postoperative analgesia and early extubation without side effects.