Abstract
We conducted a retrospective study to determine whether bupivacaine or fentanyl is a better adjuvant to epidural morphine for postoperative analgesia using 108 patients. Following epidural lidocaine anesthesia with or without light general anesthesia for major gynecological surgeries, 59 patients received epidural morphine (EPM) 2 mg (group M), 21 patients received morphine 2 mg plus 0.25% plain bupivacaine 6–10 ml epidurally (group B), and 28 patients received morphine 2 mg plus fentanyl 100 μg epidurally (group F). The analgesic interval, defined as the duration from EPM injection to the first request of analgesics for incisional pain, was significantly longer in group F than in group M (29±11vs 19±17 h,P<0.05), but similar to group B (22±14 h). Group F patients required the least amount of analgesics for incisional pain of the three groups during the first 24 h postoperatively (P<0.01). The incidence of adverse effects was similar among all three groups. In conclusion, fentanyl appears to be a better adjuvant to epidural morphine than bupivacaine.
Similar content being viewed by others
References
Cousins MJ, Mather LE (1984) Intrathecal and epidural administration of opioids. Anesthesiology 61:276–310
Bromage PR, Camporesi E, Chestnut DH (1980) Epidural narcotics for postoperative analgesia. Anesth Analg 59:473–480
Rosen MA, Hughes SC, Shnider SM, et al. (1983) Epidural morphine for the relief of postoperative pain after Cesarean delivery. Anesth Analg 62:666–672
Tanaka M, Watanabe S, Endo T, et al. (1991) Combination of epidural morphine and fentanyl for postoperative analgesia. Reg Anesth 16:214–217
Birnbach DJ, Johnson MD, Arcario T, et al. (1989) Effect of diluent on analgesia produced by epidural fentanyl. Anesth Analg 68:808–810
Gilman AG, Rall TW, Nies AS, et al. (1990) The pharmacological basis of therapeutics, 8th edn. Pergamon, New York, p 497
Furst S (1991) Pharmacological interaction of opiates with various classes of centrally acting dopaminergic drugs. Drug Metabol Drug Interact 9:77–102
Naulty JS, Parmet J, Pate A, et al. (1990) Epidural sufentanil and morphine for post-cesarean delivery analgesia. Anesthesiology 73:A965
Moore RA, Bullingham RES, Mcquay HJ, et al. (1982) Dural permeability to narcotics: in vitro determination and application to extradural administration. Br J Anaesth 54:1117–1128
Shulman M, Sandler AN, Bradley JW, et al. (1984) Postthoracotomy pain and pulmonary function following epidural and systemic morphine. Anesthesiology 61:569–575
Lema MJ, Reiestad F (1989) A comparison of epidural alfentanil, morphine and alfentanil-morphine combination for postoperative analgesia after total hip replacement. Anesthesiology 71:A702
Brockway MS, Noble DW, Sharwood GH, et al. (1990) Profound respiratory depression after extradural fentanyl. Br J Anaesth 64:243–245
Palmer CM (1991) Early respiratory depression following intrathecal fentanyl-morphine combination. Anesthesiology 74:1153–1155
Ahuja BR, Strunin L (1985) Respiratory effects of epidural fentanyl. Anaesthesia 40:949–955
Author information
Authors and Affiliations
About this article
Cite this article
Tanaka, M., Watanabe, S. & Naito, H. Comparison of bupivacaine and fentanyl as an adjuvant of epidural morphine for postoperative analgesia. J Anesth 8, 150–153 (1994). https://doi.org/10.1007/BF02514703
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02514703