Postoperative patient-controlled epidural analgesia with opioid bupivacaine mixtures

Abstract

Purpose: To determine the efficacy and safety of patient-controlled epidural analgesia of morphine of fentanyl in combination with bupivacaine for postoperative pain relief. Methods: Forty ASA I-II patients scheduled for major abdominal surgery were studied. After insertion of a lumbar epidural catheter, patients were given a non-opioid general anaesthetic. After surgery patients complaining of pain, received a loading dose of 2 mg morphine (Group I) or 50 μg fentanyl (Group II). For continuing pain, 1 mg morphine in 4 ml bupivacaine 0.125% (0.25 mg ml-1 (0.25 mg ml-1 morphine and 1 mg·ml-1 bupivacaine, Group I) or 20 μg fentanyl in 4 ml bupivacaine 0.125 % (5 μg ml-1 fentanyl and 1 mg·ml-1 bupivacaine Group II) were administered. Blood pressure, heart rate, respiratory rate and SpO2 were monitored. Assessments of pain (VAS), nausea-vomiting, motor block, pruritus and sedation were recorded for 24 hr. Results: No difference in pain or sedation was observed between groups. The 24 hr postoperative opioid consumption was 15.50 ± 7.53 mg morphine and 555.10 ± 183.55 μg fentanyl. Total bupivacaine 0.125% consumption was 58.0 ± 30.14 ml in Group I and 101.05 ± 36.77 ml in Group II. One patient in Group II complained of motor weakness in one leg. The incidence of nausea (Group I 45%, Group II 10% P < 0.05) and pruritus (Group I 30%, Group II 5% P < 0.05) was less in patients receiving fentanyl. Conclusion: Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine.