The efficacy of intravenous patient-controlled remifentanil versus morphine anesthesia after coronary artery surgery

Management of pain after coronary artery bypass graft (CABG) surgery is of particular significance for reducing postoperative complications and irnproving quality of care. Optimization of pain relief after cardiac surgery however has proved to be difficult with no one modality of therapy providing ideal efficacy with an acceptable side effect profile. The aim of our randomized double blind study was to compare the analgesic efficacy and side effect profiles of intravenous patient controlled infusions of morphine and remifentanil, both combined with paracetamol and tramadol. After obtaining the Faculty Research and Ethics Cornrnitees approval and written informed consents, 60 patients (ASA III) scheduled for elective CABG surgery with left ventricle ejection fraction >35% were randomized into 2 groups for this prospective double-blind study. At the end of cardiac surgery patients in group M were given IV morphine with an infusion rate of 0.3 rng/h and 1 mg bolus doses; group R patients were given IV remifentanil PCA with an infusion rate of 0.05 µg/kg/min, and 0.25 µg/kg bolus doses with a 5 min lockout time for both groups. Patients in both groups received paracetamol concurrently. After 24 hoıırs, IV-PCA was stopped, and the patients were given paracetamol 500 mg every 6 hours and tramadol 50 mg every 6 hours. During the first 72 hours after CABG surgery, pain during resting, moving and coughing was assessed separately by using a 10-point Numerical Rating Scale; and sedation was evaluated by using the 6-point Ramsay Sedation Scale. Patient satisfaction was noted at hospital discharge. Compared with group R, patienıs in group M reported higher NRS score during rnoving and coughing at 12th and 24th hoıırs postoperatively. Ramsay sedation scores obtained at 6th hour after surgery was lower in group R patients, as compared with patients in group M. Nausea was documented in significantly higher percentage of patienıs of group M after 24 hours, as compared with patienıs of group R. In conclusion, multimodal analgesia with IV-PCA remifentanil after CABG surgery provided more effective analgesia and less adverse effect profile than IV PCA moıplıine with high patient satisfaction.