Administration of epidural bupivacaine combined with epidural morphine after esophageal surgery.
BACKGROUND
Early tracheal extubation after esophagectomy has been postulated to reduce both morbidity rate and the cost of esophageal surgery. The purpose of this study was to determine the effect of epidural bupivacaine combined with morphine on extubation time, postoperative analgesia, respiration, and hemodynamics in patients undergoing esophagectomy.


METHODS
In a randomized double-blind study, twenty patients undergoing esophageal cancer surgery with a thoracoabdominal procedure were studied. All patients received epidural morphine 2 mg at T6-7 and 2 mg at L3-4 at the beginning of wound closure. Then 3 ml/hr continuous epidural administration of either 0.25% bupivacaine (group Bup, 10 patients) or normal saline solution (group NS, 10 patients) through the catheter inserted at T6-7 was continued for 16 hours, followed by low-dose epidural buprenorphine-bupivacaine.


RESULTS
The time from end of operation to tracheal extubation was 4.4 +/- 6.7 hours in group Bup and 13.7 +/- 7.1 hours in group NS (p < 0.05). All patients in both groups obtained moderate or adequate pain relief (visual analog scale of 21 +/- 27 mm) without serious side effects. There were no significant differences in visual analog scale, score for pain on a deep breath, blood pressure, heart rate, or respiratory rate between the two groups.


CONCLUSIONS
Continuous administration of epidural bupivacaine combined with morphine resulted in good analgesia without any respiratory or hemodynamic depression in patients who had undergone esophagectomy, and early extubation is related to the efficacy of continuous epidural administration of bupivacaine.
Terai
T
T
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan.
Yukioka
H
H
Fujimori
M
M
D000368:Aged; D015360:Analgesia, Epidural; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D012119:Respiration / Q000187:drug effects; D013997:Time Factors
D009020:Morphine; D002045:Bupivacaine