Sevoflurane requirements during coloproctologic surgery: difference between two different epidural regimens.
OBJECTIVE
To examine the influence of epidural morphine on the end-tidal sevoflurane concentration titrated to maintain bispectral index (BIS) values between 40 and 50.


METHODS
Prospective, double-blinded clinical trial.


METHODS
Anesthesia department of a university hospital.


METHODS
40 ASA physical status I, II, and III patients scheduled for elective coloproctological surgery.


METHODS
Patients were randomized to receive via a thoracic epidural catheter either a) bupivacaine 0.25% (10 mL) and saline 0.9% (2 mL) as a bolus followed by an infusion of bupivacaine 0.25% (5 mL/hr) or b) bupivacaine 0.25% (10 mL) and morphine 0.1% (2 mL) as a bolus followed by an infusion of bupivacaine 0.25% plus morphine 0.025% (5 mL/hr). Anesthesia was induced with propofol, fentanyl 2 microg kg(-1) and atracurium and maintained with sevoflurane and nitrous oxide in oxygen. Sevoflurane level was titrated to maintain a BIS value between 40 and 50. After extubation, patients were asked about the presence of pain.


RESULTS
There was no significant difference between groups of end-tidal sevoflurane concentrations at identical BIS values and hemodynamic values at any time in the study. However, the morphine group had a lower pain score level at extubation than did the plain bupivacaine group (no pain on movement, 79% vs. 31.5%, p < 0.01).


CONCLUSIONS
Adding morphine to the bupivacaine epidural solution did not reduce sevoflurane requirements but did provide high-quality postoperative analgesia, mainly just after tracheal extubation.
Koo
Maylin
M
Department of Anesthesiology, Ciutat Sanitària i Universitària de Bellvitge, Hospital Princeps d'Espanya, Feixa Llarga s/n. l'Hospitalet de Llobregat, 08907 Barcelona, Spain. 25515mkg@comb.es
Sabaté
Antoni
A
Dalmau
Antonia
A
Camprubi
Imma
I
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003106:Colon / Q000601:surgery*; D004311:Double-Blind Method; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D000077149:Sevoflurane
D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D018685:Anesthetics, Inhalation; D000779:Anesthetics, Local; D008738:Methyl Ethers; D000077149:Sevoflurane; D009020:Morphine; D002045:Bupivacaine