G. Ozalp et al., POSTOPERATIVE PATIENT-CONTROLLED EPIDURAL ANALGESIA WITH OPIOID BUPIVACAINE MIXTURES, Canadian journal of anaesthesia, 45(10), 1998, pp. 938-942
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.