Low-Dosage Morphine Aids Heart Patients.

• Position: Brief Article

A new twist on an old method of relieving pain could help heart patients recover from surgery in relative comfort without the troublesome side effects of narcotic pain medication, researchers at Robert Wood Johnson Medical School, New Brunswick, N.J., have discovered. They told the 1999 annual meeting of the American Society of Anesthesiologists that injections of morphine near the spine before coronary artery bypass graft (CABG) surgery provide patients with excellent pain relief, as well as protect them from the narcotic's negative side effects if the medication is given in very low doses. The morphine is injected with a fine needle into the fluid surrounding the spinal cord, an area known as the intrathecal space.

CABG surgery can be exceptionally painful because the surgeon must separate the breast bone in order to reach the heart. To minimize the discomfort after surgery, many patients avoid taking deep breaths, which can lead to pneumonia and other complications.

Morphine injected into the intrathecal space before surgery can provide effective pain relief for as long as 30 hours following surgery. Anesthesiologists, however, hesitate to use morphine because the standard dose can cause severe nausea, vomiting, drowsiness, and itching, lead researcher Sheldon Goldstein notes. However, according to the results of a study of 35 CABG patients, spinal injections of morphine given before surgery at one-third to one-fifth of the usual dose effectively relieve pain without the side effects, he says.

Before surgery, patients received either a spinal injection of...