Postoperative Analgesia with Intramuscular Morphine at Fixed Rate Versus Epidural Morphine or Sufentanil and Bupivacaine in Patients Undergoing Major Abdominal Surgery

• Published in: Anesthesia and analgesia Vol. 87; no. 6; pp. 1346 - 1353
• Main Authors: Broekema, Alida A, Veen, Alexander, Fidler, Vaclav, Gielen, Mathieu J. M, Hennis, Pim J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.12.1998; Lippincott
• Subjects: Abdomen - surgery; Adolescent; Adult; Aged; Analgesia, Epidural; Analgesics; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Double-Blind Method; Female; Humans; Injections, Intramuscular; Male; Medical sciences; Middle Aged; Morphine - administration & dosage; Morphine - adverse effects; Neuropharmacology; Pain Measurement; Pain, Postoperative - drug therapy; Pharmacology. Drug treatments; Preanesthetic Medication; Sufentanil - administration & dosage; Sufentanil - adverse effects; Human; Postoperative; Morphine; Opiates; Narcotic analgesic; Route of administration; Intramuscular administration; Local anesthetic; Analgesia; Chemotherapy; Regional anesthesia; Bupivacaine; Pain; Treatment; Surgery; Extradural administration; Organic amide; Drug interaction; Anilide; Comparative study; Sufentanil
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1097/00000539-199812000-00025

We assessed the efficacy and side effects of postoperative analgesia with three different pain regimens in 90 patients undergoing major abdominal surgery.The patients were randomly assigned to one of three groupsepidural morphine (EM) or sufentanil (ES), both combined with bupivacaine, or IM morphine (IM) at fixed intervals. Before incision, patients in the epidural groups received sufentanil or morphine in bupivacaine via a thoracic catheter, followed by a continuous infusion 1 h later. General anesthesia consisted of N2 O/O2 and isoflurane for all groups. Patients in all groups received IV sufentanil as part of their anesthetic management. Patients in the IM group received IV sufentanil 1 [micro sign]g/kg before incision, and patients in all groups received sufentanil 10 [micro sign]g for inadequate analgesia. Postoperatively, the epidural or IM treatment was continued for >or=to5 days. Postoperative analgesia at rest and during coughing and movement was significantly better in the epidural groups than in the IM group during the 5 consecutive days. There were no significant differences between the epidural groups. The incidence of most side effects was similar in all groups. We conclude that epidural analgesia provided better pain relief than IM analgesia, even if the latter was optimized by fixed-dose administration at fixed intervals and included adjustments on demand. Epidural sufentanil and morphine, both combined with bupivacaine, seemed to be equally effective with similar side effects. ImplicationsPostoperative analgesia with epidural sufentanil or morphine and bupivacaine after major abdominal surgery seemed to be better than the conventional method of IM morphine treatment, despite optimal administration, i.e., fixed doses at fixed intervals with regular adjustments. Analgesic efficacy and side effects of epidural sufentanil and morphine were similar.(Anesth Analg 1998;87:1346-53)