M. Berti et al., COMPARISON BETWEEN EPIDURAL INFUSION OF FENTANYL BUPIVACAINE AND MORPHINE/BUPIVACAINE AFTER ORTHOPEDIC-SURGERY/, Canadian journal of anaesthesia, 45(6), 1998, pp. 545-550
Purpose: To compare epidural infusions of bupivacaine-fentanyl and bup
ivacaine-morphine mixtures for postoperative pain relief after total h
ip replacement. Methods: in a prospective, randomized, double-blind st
udy, 30 ASA physical status I-II patients undergoing total hip replace
ment were studied. Anaesthesia was provided by combined general/epidur
al anaesthesia without epidural opioids. Postoperative epidural analge
sia was by continuous infusion of bupivacaine 0.125% (4 ml.hr(-1)) wit
h either 0.05 mg mi-l morphine (morphine, n = 15) or 0.005 mg.ml(-1) f
entanyl (fentanyl, n = 15). Visual analogue pain scale (VAS), sedation
(four-point scale), respiratory rate, pulse oximetry, rescue analgesi
cs and supplemental oxygen were recorded by a blind observer at 1,3, 6
, 9, 12 and 24 hr after surgery. Results: No differences in pain relie
f, sedation, or non-respiratory side effects were observed between the
two groups. Rescue analgesics were required in three patients in the
fentanyl group (20%) and in two receiving morphine (13.3%) (P:NS). Two
patients in the fentanyl group and three in the morphine group requir
ed oxygen due to SpO(2) < 90% (P:NS), Both opioid/bupivacaine mixtures
decreased haemoglobin oxygen saturation compared with preoperative va
lues. The mean +/- SD SpO(2) values measured at 3, 6, 12 and 24 hr wer
e 94.4 +/- 1, 92.6 +/- 0.9, 92 +/- 0.8, and 92.8 +/- 1 in the morphine
group, 95.3 +/- 0.5, 95 +/- 0.5, 94.6 +/- 1.2, and 95.6 +/- 1 in the
fentanyl group (P < 0.05). Conclusion: Continuous epidural infusion of
bupivacaine-morphine or bupivacaine-fentanyl mixtures provided simila
r pain relief. Patients receiving morphine showed a more marked decrea
se in SpO(2), than those receiving fentanyl. However, the average SpO(
2) remained > 90% in both groups.