Postoperative analgesia for major abdominal surgery with continuous thoracic epidural infusion of bupivacaine with sufentanil, versus bupivacaine with morphine. A randomized double blind study.
Forty-six patients undergoing major abdominal surgery were given postoperative epidural analgesia for four days with bupivacaine-sufentanil or bupivacaine-morphine. Both groups received a bolus of 8 ml bupivacaine 0.5% followed after 30 minutes by an infusion of 20 ml/h bupivacaine 0.1%. The sufentanil group (group A: 21 patients) received a loading dose of 50 micrograms sufentanil and a continuous infusion of 5 micrograms/h sufentanil. The morphine group (group B: 25 patients) received no loading dose of morphine but only a continuous infusion of 0.5 mg/h morphine. Both regimens provided excellent analgesia, but the frequency of respiratory depression was much greater in group A (33% versus 4% in group B). This respiratory depression occurred in the first hours postoperatively, when the patients were still in the post-anesthesia care unit. There was also a high incidence of hypotension after the loading dose of bupivacaine 0.5%. Although we noticed a large incidence of pruritus, no patient needed naloxone reversal. In view of these side effects we recommend a lower loading dose of both bupivacaine and sufentanil.
Coppe
E
E
Department of Anesthesia, Heilig Hartziekenhuis, Roeselare, Belgium.
Willaert
J
J
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D000700:Analgesics / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D011537:Pruritus / Q000139:chemically induced; D012119:Respiration / Q000187:drug effects; D017409:Sufentanil; D013904:Thoracic Vertebrae
D000700:Analgesics; D009020:Morphine; D017409:Sufentanil; D005283:Fentanyl; D002045:Bupivacaine