THORACIC EPIDURAL ANALGESIA COMPARED WITH PATIENT-CONTROLLED INTRAVENOUS MORPHINE AFTER UPPER ABDOMINAL-SURGERY

Twenty-one ASA I or II patients undergoing upper abdominal surgery wer e studied for 24 hours after operation. They were entered into a prosp ective, randomised study of patient-controlled intravenous morphine co mpared with continuous thoracic epidural fentanyl combined with 0.2% b upivacaine. Pain relief was superior in the bupivacaine series (P<0.05 ) throughout the 24 hour study period and this was associated with sig nificantly greater pulmonary ventilation compared with the PCA series. Forced expiratory parameters were reduced in both series after the op eration but significantly less so in the epidural group. There was a r educed incidence of emetic symptoms in the epidural group (P<0.05) but the incidence of other minor side effects did not differ significantl y Thoracic epidural fentanyl/bupivacaine results in significantly bett er analgesia than patient-controlled intravenous morphine.