title: Effects of combined perioperative epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine on postoperative pain, pulmonary, and endocrine-metabolic function after minilaparotomy cholecystectomy.
abstract: OBJECTIVE
  The study investigates the effects of combined perioperative continuous epidural bupivacaine and morphine, ibuprofen, and incisional bupivacaine, compared with intermittent systemic morphine, ibuprofen, and incisional bupivacaine, on postoperative pain, respiratory function, and endocrine-metabolic alterations associated with minilaparotomy cholecystectomy.
  
  
  METHODS
  Thirty-two patients scheduled for cholecystectomy, performed through a minilaparotomy, were randomized to receive general anesthesia with pre- and postoperative thoracic (T7-9) epidural analgesia with bupivacaine and morphine during 38 hours after the operation, or general anesthesia with morphine intramuscular for pain relief every 6-8 hours after the operation. All patients received ibuprofen before the operation until 6 days after the operation, and preoperative infiltration of the surgical field with bupivacaine.
  
  
  RESULTS
  Both regimens almost abolished pain at rest, whereas, addition of epidural bupivacaine and morphine significantly improved analgesia during cough and mobilization (P < .05). This improvement was not sustained beyond the expected pharmacologic effect of the epidural analgesics. The postoperative decrease in pulmonary function was only brief and there were no differences between the study groups. No increase in plasma cortisol or glucose was observed from before to 6 hours after the operation, irrespective of the anesthetic regimen.
  
  
  CONCLUSIONS
  Epidural analgesia for minilaparatomy cholecystectomy improves pain relief in the immediate postoperative period, compared to intramuscular morphine. Pulmonary and endocrine-metabolic function is not changed to such degree after minicholecystectomy that epidural analgesia can be demonstrated to have beneficial effects.
authors.affiliation: Department of Anesthesiology, Hvidovre University Hospital, Denmark.
authors.forename: J B
authors.initials: JB
authors.lastname: Dahl
authors.forename: N C
authors.initials: NC
authors.lastname: Hjortsø
authors.forename: J G
authors.initials: JG
authors.lastname: Stage
authors.forename: B L
authors.initials: BL
authors.lastname: Hansen
authors.forename: S
authors.initials: S
authors.lastname: Møiniche
authors.forename: B
authors.initials: B
authors.lastname: Damgaard
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002763:Cholecystectomy / Q000379:methods; D004702:Endocrine Glands / Q000187:drug effects / Q000378:metabolism; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007052:Ibuprofen / Q000008:administration & dosage / Q000009:adverse effects; D010535:Laparoscopy; D008168:Lung / Q000187:drug effects / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010149:Postoperative Pain / Q000517:prevention & control*; D012129:Respiratory Function Tests
chemical_list: D009020:Morphine; D006854:Hydrocortisone; D007052:Ibuprofen; D002045:Bupivacaine