title: Epidural bupivacaine-morphine analgesia versus patient-controlled analgesia following abdominal aortic surgery: analgesic, respiratory, and myocardial effects.
abstract: BACKGROUND
  The efficacy and effects of epidural analgesia compared with patient-controlled analgesia (PCA) have not been reported in patients undergoing major vascular surgery. We compared the effects of epidural bupivacaine-morphine with those of intravenous PCA morphine after elective infrarenal aortic surgery.
  
  
  METHODS
  Forty patients classified as American Society of Anesthesiologists physical status 2 or 3 received general anesthesia plus postoperative PCA using morphine sulfate (group PCA; n = 21) or general anesthesia plus perioperative epidural morphine-bupivacaine (group EPI; n = 19) during a period of 48 h. During operation, EPI patients received 0.05 mg/kg epidural morphine and 5 ml 0.25% bupivacaine followed by an infusion of 0.125% bupivacaine with 0.1% morphine (0.1 mg/ ml); group PCA received 0.1 mg/kg intravenous morphine sulfate. Continuous electrocardiographic monitoring (V4 and V5 leads) was performed from the night before surgery until 48 h afterward. Respiratory inductive plethysmographic data were recorded after tracheal extubation. Visual analog pain scores at rest and after movement were performed every 4 h after extubation.
  
  
  RESULTS
  Nurse-administered intravenous morphine and time to tracheal extubation were less in group EPI, as were visual analog pain scores at rest and after movement from 20 to 48 h. Complications and the duration of intensive care unit and hospital stay were comparable. There was a similar, low incidence of postoperative apneas, slow respiratory rates, desaturation, and S-T segment depression.
  
  
  CONCLUSIONS
  Epidural morphine-bupivacaine is associated with reduced early postoperative intravenous opioid requirements, more rapid tracheal extubation, and superior analgesia after abdominal aortic surgery, with comparable respiratory effects.
authors.affiliation: Department of Anaesthesia, The Toronto Hospital, Ontario, Canada.
authors.forename: J F
authors.initials: JF
authors.lastname: Boylan
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: B P
authors.initials: BP
authors.lastname: Kavanagh
authors.forename: J R
authors.initials: JR
authors.lastname: Klinck
authors.forename: D C
authors.initials: DC
authors.lastname: Cheng
authors.forename: W C
authors.initials: WC
authors.lastname: DeMajo
authors.forename: P M
authors.initials: PM
authors.lastname: Walker
authors.forename: K W
authors.initials: KW
authors.lastname: Johnston
authors.forename: A N
authors.initials: AN
authors.lastname: Sandler
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D001012:Aorta, Abdominal / Q000601:surgery*; D002045:Bupivacaine / Q000008:administration & dosage*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D012119:Respiration / Q000187:drug effects*
chemical_list: D009020:Morphine; D002045:Bupivacaine