Comparison between epidural infusion of fentanyl/bupivacaine and morphine/bupivacaine after orthopaedic surgery

Abstract

Purpose: To compare epidural infusions of bupivacaine-fentanyl and bupivacaine-morphine mixtures for postoperative pain relief after total hip replacement. Methods: In a prospective, randomized, double-blind study, 30 ASA physical status I-II patients undergoing total hip replacement were studied. Anaesthesia was provided by combined general/epidural anaesthesia without epidural opioids. Postoperative epidural analgesia was by continuous infusion of bupivacaine 0.125% (4 ml·hr-1) with either 0.05 mg·ml-1 morphine (morphine, n = 15) or 0.005 mg·ml-1 fentanyl (fentanyl, n = 15). Visual analogue pain scale (VAS), sedation (fourpoint scale), respiratory rate, pulse oximetry, rescue analgesics and supplemental oxygen were recorded by a blind observer at 1, 3, 6, 9, 12 and 24 hr after surgery. Results: No differences in pain relief, sedation, or non-respiratory side effects were observed between the two groups. Rescue analgesics were required in three patients in the fentanyl group (20%) and in two receiving morphine (13.3%) (P:NS). Two patients in the fentanyl group and three in the morphine group required oxygen due to SpO2 < 90% (P:NS). Both opioid/bupivacaine mixtures decreased haemoglobin oxygen saturation compared with preoperative values. The mean ± SD SpO2 values measured at 3, 6, 12 and 24 hr were 94.4 ± 1, 92.6 ± 0.9, 92 ± 0.8, and 92.8 ± 1 in the morphine group, 95.3 ± 0.5, 95 ± 0.5, 94.6 ± 1.2, and 95.6 ± 1 in the fentanyl group (P < 0.05). Conclusion: Continuous epidural infusion of bupivacaine-morphine or bupivacaine-fentanyl mixtures provided similar pain relief. Patients receiving morphine showed a more marked decrease in SpO2 than those receiving fentanyl. However, the average SpO2 remained > 90% in both groups.