Improved bowel function after gynecological surgery with epidural bupivacaine-fentanyl than bupivacaine-morphine infusion

Purpose: To compare postoperative gastrointestinal recovery between continu ous epidural bupivacaine-fentanyl and bupivacaine-morphine. Methods: In a blinded, randomized, prospective trial, 60 women undergoing s urgery for gynecologic cancer were studied. Anesthesia was provided by a co mbined general/epidural (L2-3 catheter) technique without epidural opioids: Postoperative epidural analgesia was by continuous infusion of bupivacaine 0.1% with either morphine 0.05mg.ml(-1) (BM) or fentanyl 5 mu g.ml(-1) (BF ). Visual Analogue Scale (VAS) scores for pain at rest and during movement, and the return of bowel function were collected for three days and the dur ation of hospitalization were noted. Results: On POD-1, 18.5% of patients in the BM group had emesis compared wi th none in the BF group (P = 0.038) and fewer patients in the BM group tole rated clear oral fluids (11.1% BM vs 40.6% BF, P = 0.025). These difference s became insignificant on POD-2 and 3. Median pain scores were comparable a t rest and ranged from 10-20 in the BM group vs 0-20 in the BF group over t he three days, Similarly, median pain scores with movement respectively ran ged from 20-25 and 20-30 in the BF and BM groups. The mean duration of hosp italization was longer in the BM group (5.7 +/- 2.4) vs BF (4.5 +/- 1.2 day s), P = 0.017. Conclusion: Epidural BM and BF provided equally effective postoperative ana lgesia at rest and during movement. Compared with BM, epidural BF is associ ated with less emesis and an increased ability to tolerate oral fluids on P OD-1 and an overall shorter hospital stay.