Morfina vs fentanil em cirurgia cardíaca

Interessante a análise do uso da morfina, comparando-a ao fentanil em cirurgia cardíaca!

Conclusão do artigo: Em pacientes submetidos a cc eletiva, com cec, as medidas de qualidade de vida pós-op e controle da dor na recuperação foram melhores com morfina 40 mg quando administradas intra-op como parte de anestesia balanceada com isoflurano do que comparado com fentanil.

Anesth Analg 2009; 109:311-319
© 2009 International Anesthesia Research Society

CARDIOVASCULAR ANESTHESIOLOGY

Morphine-Based Cardiac Anesthesia Provides Superior Early Recovery Compared
with Fentanyl in Elective Cardiac Surgery Patients

Glenn S. Murphy, MD, Joseph W. Szokol, MD, Jesse H. Marymont, MD, Steven B.
Greenberg, MD, Michael J. Avram, PhD, Jeffery S. Vender, MD, Saadia S.
Sherwani, MD, Margarita Nisman, BA, and Victoria Doroski, BA
>From the Department of Anesthesiology, NorthShore University HealthSystem,
Evanston, Illinois.

Address correspondence and reprint requests to Glenn S. Murphy, MD,
NorthShore Department of Anesthesiology, University HealthSystem, 2650 Ridge
Ave., Evanston, IL 60201. Address e-mail to dgmurphy2@yahoo.com.

Abstract

BACKGROUND: Experimental and clinical data suggest that morphine possesses
unique cardioprotective and antiinflammatory properties. In this clinical
investigation, we sought to determine whether the choice of intraoperative
opioid (morphine or fentanyl) influences early recovery after cardiac
surgery.

METHODS: Ninety patients undergoing cardiac surgery with cardiopulmonary
bypass were randomized to receive either morphine (40 mg) or fentanyl (600
µg) as part of a standardized opio id-isoflurane anesthetic. Quality of
recovery was assessed using the QoR-40 questionnaire administered
preoperatively and daily on postoperative days 1-3. During the first three
postoperative days, pain was measured using a 100-mm visual analog scale,
and the use of IV and oral pain medications (morphine or
acetaminophen/hydrocodone) was quantified. Hemodynamic variables, duration
of tracheal intubation, postoperative febrile reactions, organ morbidities,
and intensive care unit (ICU) and hospital length of stay were evaluated.

RESULTS: Compared with patients given fentanyl, those receiving morphine had
higher global QoR-40 scores on postoperative days 1 (173 vs 160, P <
0.0001), 2 (174 vs 164, P < 0.0001), and 3 (177 vs 167, P < 0.001).
Differences between the groups were observed in the QoR-40 dimensions of
emotional state, physical comfort, and pain (all P < 0.01-0.0001).
Postoperative visu al analog scale pain scores, use of pain medication in the
ICU and surgical ward, and postoperative febrile reactions were reduced
significantly in the morphine group (all P < 0.01). No differences between
the groups were noted in duration of tracheal intubation, ICU and hospital
length of stay, or postoperative complications.

CONCLUSIONS: In patients undergoing elective cardiac surgery with
cardiopulmonary bypass, postoperative quality-of-life measures and pain
control during recovery were enhanced when morphine (40 mg) was administered
intraoperatively as part of a balanced anesthetic technique compared with
fentanyl.