Valor de la morfina liofilizada intratecal en la revascularización miocárdica quirúrgica

Introduccion: La analgesia subaracnoidea constituye un metodo terapeutico util en la cirugia cardiaca. Objetivo: Comparar el uso de la morfina subaracnoidea e intravenosa para la analgesia postoperatoria de la revascularizacion miocardica quirurgica. Metodo: Se realizo un estudio comparativo, longitudinal en 40 pacientes, divididos en dos grupos. El de analgesia subaracnoidea recibio morfina liofilizada 15 mcg/kg, y el grupo de morfina intravenosa, 0,3 mg/kg previo y posterior a la cirugia. Resultados: Predomino el sexo femenino, las edades y los pesos promedio de ambos grupos fueron similares (p > 0.05). El 90 % de los enfermos del grupo de morfina subaracnoidea tuvo una analgesia excelente a las 8 horas de la intervencion, y se mantuvo entre buena y excelente a las 12 y 24 horas posteriores, respectivamente; mientras que solo el 50 % de los pacientes de morfina intravenosa refirio una analgesia buena a las 8 horas de operados; y a las 24 horas, todos se quejaron de una analgesia insuficiente o mala (p < 0.05). El tiempo total promedio de analgesia postoperatoria obtenida en el grupo de morfina intratecal fue de 24,41 horas y en el de morfina intravenosa, de 8,76 horas (p < 0.01). Los principales efectos adversos fueron el prurito para ambos grupos, y la hipotension y la bradicardia para el grupo con morfina intravenosa, aunque las diferencias no fueron significativas. Conclusiones: La morfina subaracnoidea demostro su utilidad como agente analgesico en la revascularizacion miocardica quirurgica, con mejor y mas prolongada analgesia que los enfermos tratados con morfina intravenosa.

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