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CARDIOVASCULAR ANESTHESIA

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

Marie-Hélène Fléron, MD^*, Richard B. Weiskopf, MD, Michèle Bertrand, MD^*, Stéphane Mouren, MD PhD, Daniel Eyraud, MD^*, Gilles Godet, MD^*, Bruno Riou, MD PhD^*, Edouard Kieffer, MD^*, and Pierre Coriat, MD^*

*Departments of Anesthesiology and Critical Care, and Vascular Surgery, CHU Pitié-Salpêtrière; Department of Anesthesiology, Institut Mutualiste Montsouris, Paris, France; and Department of Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California

Address correspondence and reprint requests to Richard B. Weiskopf, MD, Department of Anesthesia, C450, Box 0648, University of California, San Francisco, CA 94143–0648, or 94122 for non-US postal delivery. Address e-mail to weiskopf{at}anesthesia.ucsf.edu

Major surgery evokes a stress response that can produce deleterious consequences, especially in a population at high risk for those complications. We tested the hypothesis that decreasing or eliminating one of the sources of stress by providing intense analgesia in the immediate postoperative period via application of neuraxial opioids would decrease major nonsurgical complications. Two-hundred-seventeen patients scheduled to undergo abdominal aortic surgery were randomly allocated to receive either general anesthesia alone (control) or general anesthesia combined with intrathecal opioid (1 µg/kg sufentanil with 8 µg/kg preservative-free morphine injected at the L4–5 interspace). Postoperative care was identical in the two groups, including patient-controlled analgesia. Each patient provided an assessment of postoperative pain using a visual analog scale. Postopera-tive complications were recorded according to criteria established a priori. The administration of intrathecal opioid provided more intense analgesia than patient-controlled analgesia during the first 24 h postoperatively (P < 0.05). There was no difference between groups for the incidence of combined major cardiovascular, respiratory, and renal complications (P > 0.05) or mortality (P > 0.05). The incidence of myocardial damage or infarction, as defined by abnormal plasma concentration of troponin I, did not differ between the two groups (P > 0.05). In patients undergoing major abdominal vascular surgery, decrease of one contributor to postoperative stress, by provision of intense analgesia for the intraoperative and initial postoperative period, via application of neuraxial opioid, does not alter the combined major cardiovascular, respiratory, and renal complication rate.

IMPLICATIONS: Provision of intense analgesia for the initial postoperative period after major abdominal vascular surgery, via the administration of neuraxial opioid, does not alter the combined incidence of major cardiovascular, respiratory, and renal complications.

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