EPIDURAL BUPIVACAINE-MORPHINE ANALGESIA VERSUS PATIENT-CONTROLLED ANALGESIA FOLLOWING ABDOMINAL AORTIC-SURGERY - ANALGESIC, RESPIRATORY, AND MYOCARDIAL EFFECTS

Background The efficacy and effects of epidural analgesia compared wit h patient-controlled analgesia (PCA) have not been reported in patient s undergoing major vascular surgery. We compared the effects of epidur al bupivacaine-morphine with those of intravenous PCA morphine after e lective infrarenal aortic surgery. Methods: Forty patients classified as American Society of Anesthesiologists physical status 2 or 3 receiv ed general anesthesia plus postoperative PCA using morphine sulfate (g roup PCA; n = 21) or general anesthesia plus perioperative epidural mo rphine-bupivacaine (group EPI; n = 19) during a period of 48 h. During operation, EPI patients received 0.05 mg/kg epidural morphine and 5 m l 0.25% bupivacaine followed by an infusion of 0.125% bupivacaine with 0.1% morphine (0.1 mg/ mi); group PCA received 0.1 mg/kg intravenous morphine sulfate. Continuous electrocardiographic monitoring (V4 and V 5 leads) was performed from the night before surgery until 48 h afterw ard Respiratory inductive plethysmographic data were recorded after tr acheal extubation. Visual analog pain scores at rest and after movemen t were performed every 4 h after extubation. Results: Nurse-administer ed intravenous morphine and time to tracheal extubation were less in g roup EPI, as were visual analog pain scores at rest and after movement from 20 to 48 it Complications and the duration of intensive tare uni t and hospital stay mere comparable. There was a similar, low incidenc e of postoperative apneas, slow respiratory rates, desaturation, and S -T segment depression. Conclusions Epidural morphine-bupivacaine is as sociated with reduced early postoperative intravenous opioid requireme nts, more rapid tracheal extubation, and superior analgesia after abdo minal aortic surgery, with comparable respiratory effects.