Background and Goal of Study:
One of the major concerns in neurosurgical patients is emergence. The idea is to allow early neurological examination and reintervention if necessary. More than two decades of quest for an ideal anaesthetic agents to fast track recovery has not yielded conclusive results. Long acting opoids like morphine are not popular for use in neurosurgical patients and the acceptability is for short acting opioids. However there is paucity of data which compares morphine and short acting opioids with regards to their emergence profile in neurosurgical patients. This study was done to evaluate the emergence characteristics of morphine when compared to fentany in patients undergoing elective neurosurgery.
The data of two major tertiary health care institutes of India were compared . One institute predominantly uses morphine while the other uses fentanyl for perioperative analgesia in patients undergoing neurosurgery. The patients who underwent elective supratentorial craniotomy and followed similar emergence technique (low dose propofol along with nitrous oxide in oxygen) were included in the study. The dose of opioids were based on the protocol of individual institution. The patients of morphine group (Group M) received single dose morphine 0.1mg/kg prior to induction. The fentany group (Group F) received 2 ug/kg of fentanyl at induction, 1ug/kg prior to skin incision and at beginning of dural closure. In both groups Fentanyl 1ug/kg was given as additional dose if required. Following surgery, the trachea was extubated after reversal of residual neuromuscular blockade once the patients opened eyes or responded to verbal commands. The emergence chararacteristic among the two groups were compared.
A total of eighty four patients qualified for inclusion in the study. There were thirty-seven patients in Group M while Group F had forty-seven patients. The mean time to emergence (time from cessation of anaesthesia to extubation) was 8.5 ± 3.7 minutes in group M and 7.8 ± 5.1 minutes in group F ( p = 0.11). The patients who had early emergence (< 15 minutes following cessation of anaesthesia) were 35 (94%) in group M while it were 43(91%) in group F (p= 0.69).
When used judiciously, morphine appears acceptable and similar to fentany for facilitating early emergence in patients undergoing elective supratentorial craniotomy.
© 2012 European Society of Anaesthesiology