title: Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients.
abstract: BACKGROUND
  We prospectively studied surgical cancer patients who received epidural bupivacaine-morphine to determine perioperative morphine use, side effects, and complications.
  
  
  METHODS
  All study patients received general-epidural anesthesia followed by epidural analgesia with 0.05% or 0.1% bupivacaine and 0.01% morphine at a rate of 5-10 ml.h-1 to keep the dynamic pain score at less than 5 (of 10). Patients were evaluated daily for pain relief, side effects, catheter migration, accidental removal, hypotension, respiratory rate, mental status changes, nausea and vomiting, and pruritus.
  
  
  RESULTS
  Over 4 yr, 4,227 patients (61% women, aged 68 +/- 24 yr) were studied. Lumbar epidural catheters (n = 2,248 or 53.18%) were used more frequently than thoracic catheters (n = 1,979 or 46.82%) (P < 0.00001). Most of the patients were discharged to the surgical wards after the procedures (n = 3,001, 71%). Those patients (n = 1,226, 29%) admitted to the surgical intensive care unit, spent 1.2 +/- 0.8 days. Epidural catheter failure occurred in 283 (6.3%) patients. Length of epidural analgesia therapy was 6.3 +/- 2.6 days. There were three cases (0.07%) of respiratory depression which were treated with oxygen, intravenous naloxone, and by stopping the epidural infusion for 6 h. Hypotension occurred in 126 patients (3%). There were no apparent cases of catheter migration to either the subdural or subarachnoid space. Nausea or vomiting occurred in 929 patients (22%). Pruritus occurred in 930 patients (22%).
  
  
  CONCLUSIONS
  Continuous epidural analgesia with 0.05-0.1% bupivacaine and 0.01% morphine is an effective method of postoperative analgesia with a low incidence of side effects, that can be safely administered on the surgical wards with no special monitoring equipment.
authors.affiliation: Department of Anesthesiology, Critical Care, and Pain Medicine, Roswell Park Cancer Institute, State University of New York, Buffalo School of Medicine and Biomedical Sciences.
authors.forename: O A
authors.initials: OA
authors.lastname: de Leon-Casasola
authors.forename: B
authors.initials: B
authors.lastname: Parker
authors.forename: M J
authors.initials: MJ
authors.lastname: Lema
authors.forename: P
authors.initials: P
authors.lastname: Harrison
authors.forename: J
authors.initials: J
authors.lastname: Massey
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use*; D002408:Catheters, Indwelling / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000139:chemically induced; D009369:Neoplasms / Q000601:surgery*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012131:Respiratory Insufficiency / Q000139:chemically induced; D014839:Vomiting / Q000139:chemically induced
chemical_list: D004338:Drug Combinations; D009020:Morphine; D002045:Bupivacaine