A Comparison of Intrathecal Opioid and Intravenous Analgesia for the Incidence of Cardiovascular,Respiratory,and Renal Complications after Abdominal Aortic Surgery

Abstract

A multifaceted stress response occurs as a result of surgery that can produce a variety of symptoms that increase morbidity and adverse cardiac events. The authors studied whether providing intense analgesia in order to eliminate or decrease a source of stress following the surgical procedure would decrease major nonsurgical complications. Patients were randomized to receive either general anesthesia combined with intrathecal opioid or general anesthesia alone (control). Both groups received patient-controlled anesthesia postoperatively and identical postoperative care. A visual analog scale rating postoperative pain was given to each patient. Although the group that received intrathecal opioids experienced more intense analgesia than the other group, the groups did not differ in the incidence of major cardiovascular, respiratory and renal complications, nor did they differ in myocardial damage or infarction. The authors concluded that providing intense analgesia via neuraxial opioids, does not alter the combined major cardiovascular, respiratory and renal complication rate.

Keywords

surgical stress response regional analgesia

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References

1. Tuman KJ , McCarthy RJ , March RJ , et al: Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesth Analg 73:696-704, 1991.

2. Christensen P , Brandt M , Rem J , et al: Influence of extradural morphine on the adrenocortical and hyperglycemic responses to surgery. Br J Surg 43:23-27, 1982.

3. Weissman C : The metabolic response to stress: An overview and update. Anesthesiology 73:308-327, 1990.

4. Samama CM , Thiry D , Elalamy I , et al: Perioperative activation of hemostasis in vascular surgery patients. Anesthesiology 94:74-78, 2001.

5. Perler BA , Christopherson R , Rosenfeld BA , et al: The influence of anesthetic method on infrainguinal bypass graft patency: A closer look. Am Surg 61:784-789, 1995.

6. Christopherson R , Beattie C , Frank SM , et al: Perioperative ischemia randomized anesthesia trial study group: Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology 79:422-434, 1993.

7. Norris EJ , Beattie C Perler BA , et al: Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery. Anesthesiology 95:1054-1067, 2001.