Preoperative infiltration of the surgical area enhances postoperative analgesia of a combined low-dose epidural bupivacaine and morphine regimen after upper abdominal surgery.
In a randomized, blinded trial we assessed the value of adding preoperative infiltration of the surgical area with bupivacaine to a low dose epidural regimen for postoperative pain treatment. Forty-nine patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anaesthesia were studied. Postoperative analgesia was epidural bupivacaine 10 mg/hr-1 + morphine 0.2 mg/hr-1 for 72 h. The patients randomly received preoperative infiltration of the surgical area with bupivacaine 0.25%, 40 ml (group I); or no infiltration (group II). Pain was evaluated at rest, during cough and during mobilization six and eight h after start of surgery, and at 8 a.m. and 4 p.m. on the following days until 72 h after start of surgery. The sensory level of analgesia was evaluated by pin prick. We found no difference between the two groups during rest and cough. However, during mobilization group I had lower pain scores compared to group II (P < 0.05). There was a significant reduction in the need for supplemental intramuscular morphine in the treatment group compared to the control group (P < 0.05). Thus an enhanced analgesic effect was demonstrated by adding preoperative infiltration of the surgical area with local anaesthetic to a low dose epidural bupivacaine/morphine regimen after upper abdominal surgery.
Department of Anaesthesiology, Herlev Hospital, University of Copenhagen, Denmark.
J
J
Bartholdy
K
K
Sperling
M
M
Ibsen
K
K
Eliasen
T
T
Mogensen
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000368:Aged; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage*; D003371:Cough / Q000503:physiopathology; D062109:Dermatologic Surgical Procedures; D004311:Double-Blind Method; D004338:Drug Combinations; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009068:Movement / Q000502:physiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011187:Posture / Q000502:physiology; D011300:Preoperative Care
D004338:Drug Combinations; D009020:Morphine; D002045:Bupivacaine