title: Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery.
abstract: In a double-blind study, we investigated the effects of postoperative epidural local anaesthetic, with or without addition of epidural morphine, on postoperative pain and gastrointestinal function in patients scheduled for radical hysterectomy and pelvic lymphadenectomy. Forty patients were randomized into two study groups: 48-h postoperative epidural 0.2% bupivacaine 8 ml h(-1) (bupi group) or 48-h postoperative epidural 0.2% bupivacaine/morphine 50 microg at 4 ml h(-1) (bupi/morph group). Patients were observed for at least 96 h after surgery. No differences in pain at rest, during cough or mobilization were observed. Patients in the bupi group requested a significant greater amount of supplementary analgesics, but times to first flatus and defaecation were reduced compared with patients in the bupi/morph group. Itching was a significant problem in patients in the bupi/morph group. No differences in postoperative nausea and vomiting, mobilization or time to discharge from hospital were observed between groups. The addition of morphine to postoperative epidural bupivacaine has only limited effect on pain relief and increases time to normalization of gastrointestinal function.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Herlev University Hospital, Copenhagen County, Denmark.
authors.forename: H
authors.initials: H
authors.lastname: Jørgensen
authors.forename: J S
authors.initials: JS
authors.lastname: Fomsgaard
authors.forename: J
authors.initials: J
authors.lastname: Dirks
authors.forename: J
authors.initials: J
authors.lastname: Wetterslev
authors.forename: B
authors.initials: B
authors.lastname: Andreasson
authors.forename: J B
authors.initials: JB
authors.lastname: Dahl
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D003672:Defecation / Q000187:drug effects; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010388:Pelvis / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011184:Postoperative Period
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004338:Drug Combinations; D009020:Morphine; D002045:Bupivacaine