EFFECTS OF COMBINED PERIOPERATIVE EPIDURAL BUPIVACAINE AND MORPHINE, IBUPROFEN, AND INCISIONAL BUPIVACAINE ON POSTOPERATIVE PAIN, PULMONARY, AND ENDOCRINE-METABOLIC FUNCTION AFTER MINILAPAROTOMY CHOLECYSTECTOMY

Background and Objectives. The study investigates the effects of combi ned perioperative continuous epidural bupivacaine and morphine, ibupro fen, and incisional bupivacaine, compared with intermittent systemic m orphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy. Methods. Thirty-two patients sche duled for cholecystectomy, performed through a minilaparotomy, were ra ndomized to receive general anesthesia with pre- and postoperative tho racic (T7-9) epidural analgesia with bupivacaine and morphine during 3 8 hours after the operation, or general anesthesia with morphine intra muscular for pain relief every 6-8 hours after the operation. All pati ents received ibuprofen before the operation until 6 days after the op eration, and preoperative infiltration of the surgical field with bupi vacaine. Results. Both regimens almost abolished pain at rest, whereas , addition of epidural bupivacaine and morphine significantly improved analgesia during cough and mobilization (P < .05). This improvement w as not sustained beyond the expected pharmacologic effect of the epidu ral analgesics. The postoperative decrease in pulmonary function was o nly brief and there were no differences between the study groups. No i ncrease in plasma cortisol or glucose was observed from before to 6 ho urs after the operation, irrespective of the anesthetic regimen. Concl usions. Epidural analgesia for minilaparatomy cholecystectomy improves pain relief in the immediate postoperative period, compared to intram uscular morphine. Pulmonary and endocrine-metabolic function is not ch anged to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects.