BUPIVACAINE 0.125-PERCENT IMPROVES CONTINUOUS POSTOPERATIVE EPIDURAL FENTANYL ANALGESIA AFTER ABDOMINAL OR THORACIC-SURGERY

The addition of 0.125% and 0.25% bupivacaine to continuous postoperati ve epidural infusions of fentanyl, in a 10 mu g.mi(-1) concentration, were studied in 39 patients following abdominal or thoracic surgery in prospective, random, double-blind fashion. Patients received an initi al bolus of 0.1 ml.kg(-1) of the the study solution and an infusion of 6 ml.hr(-1) which was titrated to maintain analgesia (VAS < 40). Asse ssments of pain (VAS), pulmonary function (pH, PaCO2), and bowel funct ion (time to flatus or po fluids) were made until the second postopera tive morning. There was a difference among the three groups in analges ia (means VAS scores) over time (P < 0.01), with the fentanyl-alone gr oup producing less analgesia than the 0.125% bupivacaine group (P < 0. 01). There was no difference in the average infusion rates, postoperat ive pulmonary function, or bowel function. The incidence of side effec ts including somnolence, nausea and vomiting, and pruritus was also si milar.