title: Comparison of intramuscular analgesia, intercostal block, epidural morphine and on-demand-i.v.-fentanyl in the control of pain after upper abdominal surgery.
abstract: Eighty patients undergoing upper abdominal surgery were randomly allocated to four groups according to the postoperative pain treatment. All patients had a standardized balanced anaesthesia and for postoperative analgesia either intramuscular oxycodone and/or metamizol (IM), intercostal block with 0.5% bupivacaine (IC), epidurally 4 mg morphine (EM) or i.v. infusion of fentanyl 0.54-0.99 micrograms min-1 + on-demand boluses of 7.2-13.5 micrograms (ODAC) were given. The pain intensity 2 h postoperatively was similar in all groups, mean score ranging from 3.2-4.3 on a scale from 0-10. At 24 h also, when additional intramuscular analgesics had been administered if needed, the mean pain scores did not vary much; 2.4 in the ODAC group to 3.4 in the IC group. The time until the first request for additional analgesia was longer in the EM group than in the IM group (7.5 h vs. 3.5 h). There were no differences between the groups in chest X-ray, peak expiratory flow or respiratory rate postoperatively, but in the capillary blood-gas analyses there was a greater number of slightly elevated PCO2 values (6.0-7.3 kPa) in the ODAC group than in the others. The amount of fentanyl infused in 24 h to the ODAC patients varied considerably, 814-2233 micrograms, as did the number of on-demand boluses, 3-155. At 24 h, an efficacy rating "good" was distributed as follows: IM 9/20, IC 11/20, EM 11/20 and ODAC 13/20. In the whole patient material 92.5% rated their condition as "good" or "fair".
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000698:Analgesia / Q000379:methods*; D001561:Benzilates / Q000008:administration & dosage; D001577:Benzophenones / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004177:Dipyrone / Q000008:administration & dosage; D004338:Drug Combinations / Q000008:administration & dosage; D004824:Epidural Space; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007263:Infusions, Parenteral; D007267:Injections; D007273:Injections, Intramuscular; D007366:Intercostal Muscles / Q000294:innervation; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block; D010098:Oxycodone / Q000008:administration & dosage; D010149:Postoperative Pain / Q000188:drug therapy*; D012119:Respiration / Q000187:drug effects
chemical_list: D001561:Benzilates; D001577:Benzophenones; D004338:Drug Combinations; D004177:Dipyrone; D009020:Morphine; C031519:litalgin; D010098:Oxycodone; D005283:Fentanyl; D002045:Bupivacaine