title: Mood during epidural patient-controlled analgesia with morphine or fentanyl.
abstract: BACKGROUND
  Mood states during epidural opioids are not known. The authors studied the change in mood during the 48-h period of epidural morphine and epidural fentanyl in 47 patients after elective hip or knee joint arthroplasty.
  
  
  METHODS
  An epidural catheter was inserted at the L2-L3 or L3-L4 interspace. Anesthesia was induced with thiopenthal and maintained with isoflurane and nitrous oxide. One hour before the conclusion of the operation, patients received an epidural bolus injection of 2 mg morphine (n = 23) or 100 microg fentanyl (n = 24), followed by the same opiate (125 microg/ml morphine or 25 microg/ml fentanyl) epidurally delivered by a patient-controlled analgesia (PCA) pump in the postoperative period for 48 h. Mood was assessed using the bipolar form of the Profile of Mood States before operation and 24 h, 48 h, and 72 h after operation.
  
  
  RESULTS
  There was no significant difference in pain intensity between the groups during epidural PCA. Mood states became more positive over time in the patients who received morphine (P < 0.01 at 48 h) and negative in those who were given fentanyl (P < 0.01 at 24 and 48 h, respectively) compared with those before the operation, and they were more positive in the morphine than in the fentanyl group at 24 h, 48 h (P < 0.05), and 72 h (P < 0.01). Patients in the morphine group were more composed, agreeable, elated, confident, energetic, and clearheaded than were those in the fentanyl group (P < 0.05). There was no correlation between mood scores and pain scores in either group. There was an inverse correlation at 48 h between mood scores and plasma fentanyl concentrations (r = -0.58, P < 0.05).
  
  
  CONCLUSIONS
  Mood states are significantly more positive during epidural morphine PCA than they are during epidural fentanyl PCA.
authors.affiliation: Department of Anesthesiology, University of Louisville, School of Medicine, Kentucky 40292, USA. plbesns01@ulkyvm.louisville.edu
authors.forename: K
authors.initials: K
authors.lastname: Tsueda
authors.forename: P J
authors.initials: PJ
authors.lastname: Mosca
authors.forename: M F
authors.initials: MF
authors.lastname: Heine
authors.forename: G E
authors.initials: GE
authors.lastname: Loyd
authors.forename: D A
authors.initials: DA
authors.lastname: Durkis
authors.forename: A L
authors.initials: AL
authors.lastname: Malkani
authors.forename: H E
authors.initials: HE
authors.lastname: Hurst
mesh_terms: D000328:Adult; D000339:Affect / Q000187:drug effects*; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000097:blood / Q000494:pharmacology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D005283:Fentanyl