ADMINISTRATION OF EPIDURAL BUPIVACAINE COMBINED WITH EPIDURAL MORPHINE AFTER ESOPHAGEAL SURGERY

Background. Early tracheal extubation after esophagectomy has been pos tulated to reduce both morbidity rate and the cost of esophageal surge ry. The purpose of this study was to determine the effect of epidural bupivacaine combined with morphine on extubation time, postoperative a nalgesia, respiration, and hemodynamics in patients undergoing esophag ectomy. Methods. In a randomized double-blind study, twenty patients u ndergoing esophageal cancer surgery with a thoracoabdominal procedure were studied. All patients received epidural morphine 2 mg at T6-7 and 2 mg at L3-4 at the beginning of wound closure. Then 3 ml/hr continuo us epidural administration of either 0.25% bupivacaine (group Bup, 10 patients) or normal saline solution (group NS, 10 patients) through th e catheter inserted at T6-7 was continued for 16 hours, followed by lo w-dose epidural buprenorphine-bupivacaine. Results. The time from end of operation to tracheal extubation was 4.4 +/- 6.7 hours in group Bup and 13.7 +/- 7.1 hours in group NS (p < 0.05). All patients in both g roups obtained moderate or adequate pain relief (visual analog scab of 21 +/- 27 mm) without serious side effects. There were no significant differences in visual analog scale, score for pain on a deep breath, blood pressure, heart rate, or, respiratory rate between the two group s. Conclusions. Continuous administration of epidural bupivacaine comb ined with morphine resulted in good analgesia without any respiratory or hemodynamic depression in patients who had undergone esophagectomy, and early extubation is related to the efficacy of continuous epidura l administration of bupivacaine.