POSTOPERATIVE PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH OPIOID BUPIVACAINE MIXTURES

Purpose: To determine the efficacy and safety of patient-controlled ep idural analgesia of morphine or fentanyl in combination with bupivacai ne for postoperative pain relief. Methods: Forty ASA I-ii patients sch eduled for major abdominal surgery were studied, After insertion of a lumbar epidural catheter, patients were given a non-opioid general ana esthetic, After surgery patients complaining of pain, received a loadi ng dose of 2 mg morphine (Group I) or 50 mu g fentanyl (Group ii). For continuing pain, 1 mg morphine in 4 mi bupivacaine 0.125% (0.25 mg.ml (-1) morphine and 1 mg.ml(-1) bupivacaine, Group I) or 20 mu g fentany l in 4 mi bupivacaine 0.125% (5 mu g.ml(-1) fentanyl and 1 mg.ml(-1) b upivacaine Group ii) were administered. Blood pressure, heart rate, re spiratory rate and SpO(2) were monitored. Assessments of pain (VAS), n ausea-vomiting, motor block, pruritus and sedation were recorded for 2 4 hr. Results: No difference in pain or sedation was observed between groups. The 24 hr postoperative opioid consumption was 15.50 +/- 7.53 mg morphine and 555.10 +/- 183.85 mu g fentanyl, Total bupivacaine 0.1 25% consumption was 58.00 +/- 30.14 ml in Group I and 101.05 +/- 36.77 mi in Group II. One patient in Group II complained of motor weakness in one leg. The incidence of nausea (Group I 45%, Group II 10% P < 0.0 5) and pruritus (Group I 30%, Group II 5% P < 0.05) was less in patien ts receiving fentanyl. Conclusion: Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine.