Preoperative Analgesia with Epidural Morphine

• Published in: Anesthesia and analgesia Vol. 79; no. 2; pp. 298 - 302
• Main Authors: Nègre, I., Guéneron, J. P, Jamali, S. J., Monin, S., Ecoffey, c.
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD International Anesthesia Research Society 01.08.1994; Lippincott
• Subjects: Adult; Aged; Analgesia, Epidural; Analgesics; Biological and medical sciences; Double-Blind Method; Female; Humans; Male; Medical sciences; Middle Aged; Morphine - administration & dosage; Neuropharmacology; Pain, Postoperative - prevention & control; Pharmacology. Drug treatments; Premedication; Prospective Studies; Treatment Outcome; Human; Postoperative; General anesthesia; Morphine; Opiates; Narcotic analgesic; Prevention; Chemotherapy; Pain; Treatment; Surgery; Extradural administration; Preoperative
• ISSN: 0003-2999; 1526-7598
• DOI: 10.1213/00000539-199408000-00017

In a prospective double-blind study, we examined the effects of preoperative epidural morphine associated with general anesthesia (GA) on intra- and postoperative analgesic requirements over a 3-day postoperative period. Twenty patients scheduled for major intra- abdominal surgery were randomly assigned to two groupsa control group (n = 10) and an epidural group (n = 10) which received an epidural injection of 5 mg of preservative-free morphine in 10 mL of 0.9% saline. Afterward, both groups received the same GA. Postoperative pain relief was achieved with intravenous (IV) boluses of morphine using a patient-controlled analgesia device. We found smaller opioid requirements in the epidural group than in the control group for intraoperative fentanyl (465 ± 179 μg vs 983 ± 682 μg), for postoperative morphine at 12 h (3.1 ± 3 mg vs ± 21.4 13.8 mg) and 24 h (9.1 ± 6.4 mg vs 20.6 ± 9.8 mg), and for the cumulated needs over the 3-day postoperative period (37 ± 24 μg vs 86 ± 42 mg). The consumption of IV morphine by the control group decreased over time (P < 0.001, r = 0.44), whereas, in the epidural group, consumption remained constant and small during the 3 days. The maximum pain score was significantly lower in the epidural group than in the control group at 24 h (0.65 ± 1.4 vs 3 ± 2), at 36 h (0.3 ±0.6 vs 3 ± 2.7), and at 60 h (0.1 ± 0.3 vs 1.8 ± 1.2) after surgery. These results suggest that a single epidural injection of 5 mg of morphine before major surgery produces intra- and postoperative pain relief for at least 3 days.