EPIDURAL BOLUS CLONIDINE MORPHINE VERSUS EPIDURAL PATIENT-CONTROLLED BUPIVACAINE/SUFENTANIL - QUALITY OF POSTOPERATIVE ANALGESIA AND COST-IDENTIFICATION ANALYSIS/

We compared the costs, quality of analgesia, and side effects of posto perative patient-controlled epidural analgesia (PCEA) with bupivacaine /sufentanil versus an epidural bolus (BOLUS) of clonidine/morphine in 68 patients with pancreatic surgery. Postoperative pain treatment was performed over 4 days: the PCEA pump was filled with bupivacaine 0.25% and sufentanil 2 mu g/mL and set to 3-mL bolus and 10-min lockout tim e. BOLUS patients received injections of clonidine 150 mu g plus morph ine 2 mg on demand. Visual analog scale (VAS) score at rest and during coughing, heart rate (HR), systolic arterial pressure (SAP), incidenc e of postoperative nausea and vomiting, pruritus, duration of intestin al paralysis, hospital treatment, and costs for personnel and material were recorded. VAS scores during coughing (3 +/- 2.5 vs 5 +/- 3, P <0 .001) was higher, and HR (79 +/- 13 vs 89 +/- 15, P <0.001) and SAP (1 10 +/- 18 vs 124 +/- 23, P <0.001) were lower, in the BOLUS compared w ith the PCEA group. The incidence of hypotension (SAP <80 mm Hgf was g reater (6 vs 0, P <0.001) in the BOLUS group. The incidence of all oth er side effects was comparable. The costs of personnel ($204 +/- $40 v s $166 +/- $38, P <0.001) were higher in the BOLUS group, but the cost s of material ($51 +/- $17 vs $87 +/- $18, P <0.001) were higher in th e PCEA group. Total costs ($62 +/- $9 vs $62 +/- $11 per day, P = 0.9) were comparable. We conclude that because of superior analgesia and r educed side effects at analogous costs, PCEA is preferable to the BOLU S technique for the treatment of postoperative pain. Implications: An epidural clonidine/morphine bolus technique resulted in inferior analg esia, more side effects, and comparable costs compared with a bupivaca ine/sufentanil patient-controlled regimen in a randomized controlled t rial after abdominal surgery.