Abstract
To assess the effect of postoperative continuous thoracic epidural infusion of bupivacaine on pulmonary function, a prospective randomized study was conducted in patients undergoing upper abdominal surgery (UAS). Sixteen patients, divided into two treatment groups, received continuous epidural infusion of 0.25% bupivacaine at a rate of 2–5 ml·hr−1, or that of a combination of 0.125% or 0.25% bupivacaine and 0.0025% or 0.005% morphine at a rate of 2–4 ml·hr−1. One, 4, 10, 16, 24 and 40 hr postoperatively, the following indices were measured: visual analogue scale score, modified Prince Henry pain scale score, arterial PaO 2 and PaCO 2, functional residual capacity (FRC), and tidal volume (TV). There was no difference in pain scores between the two groups except for significantly less pain at 40 hr in the combination group. Postoperative measurements of pulmonary function revealed a significant fall in PaO 2, FRC and TV, indicating a reduction of 15–25% as compared with the preoperative values, and no significant differences between the two groups. The authors conclude that postoperative continuous epidural infusion of bupivacaine combined with morphine is highly effective in alleviating pain and improving pulmonary function in patients following UAS.
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References
Ali J, Weisel RD, Layug AB, Kripke BJ, Hechtman HB: Consequences of postoperative alterations in respiratory mechanics. Am J Surg 128:376–382, 1974
Meyers JR, Lembeck L, O’Kane H, Baue AE: Changes in functional residual capacity of the lung after operation. Arch Surg 110:576–583, 1975
Craig DB: Postoperative recovery of pulmonary function. Anesth Analg 60:46–52, 1981
Latimer RG, Dickman M, Day WC, Gunn ML, Schmidt CD: Ventilatory patterns and pulmonary complications after upper abdominal surgery by determined preoperative and postoperative computerized spirometry and blood gas analysis. Am J Surg 122:622–632, 1971
Alexander JI, Spence AA, Parikh RK, Stuart B: The role of airway closure in postoperative hypoxaemia. Br J Anaesth 45:34–40, 1973
Mankikian B, Cantineau JP, Bertrand M, Kieffer E, Sartene R, Viars P: Improvement of diaphragmatic function by a thoracic extradural block after upper abdominal surgery. Anesthesiology 68:379–386, 1988
Bromage PR: Epidural analgesia, Drugs and equipment. Philadelphia, W.B. Saunders, 1978, pp. 305
Sakura S, Uchida H, Saito Y, Asano M, Kosaka Y: Continuous epidural infusion for postoperative pain relief: A comparison of three regimens. J Anesth 4:138–144, 1990
Torda TA, Pybus DA: Extradural administration of morphine and bupivacaine. Br J Anaesth 56:141–146, 1984
Bonnet F, Biery C, Zatan M, Simonet O, Brage D, Gaudy J: Effect of epidural morphine on post-operative pulmonary dysfunction. Acta Anaesthesiol Scand 28:147–151, 1984
Sakura S, Nakatani T, Kosaka Y, Tanaka A: Effect of continuous epidural morphine on postoperative pulmonary dysfunction. Hiroshima J Anesth 25:33–39, 1989 (in Japanese)
Benhamou D, Samii K, Noviant Y: Effect of analgesia on respiratory muscle function after upper abdominal surgery. Acta Anaesthesiol Scand 27:22–25, 1983
Simonneau G, Vivien A, Sartene R, Kunstlinger F, Samii K, Noviant Y, Duroux P: Diaphragm dysfunction induced by upper abdominal surgery, role of postoperative pain. Am Rev Respir Dis 128:899–903, 1983
Dureuil B, Viires N, Cantineau JP, Aubier M, Desmonts JM: Diaphragmatic contractility after upper abdominal surgery. J Appl Physiol 61:1775–1780, 1986
Duggan J, Drummond GB: Activity of lower intercostal and abdominal muscle after upper abdominal surgery. Anesth Analg 66:852–855, 1987
Jones JG: Anaesthesia and atelectasis: the role of VTAB and the chest wall. Br J Anaesth 59:949–953, 1987
Albano JP, Garnier L: Bulbo-spinal respiratory effects originating from the splanchnic afferents. Respir Physiol 51:229–239, 1983
Shannon R: Intercostal and abdominal muscle afferent influence on medullary dorsal respiratory group neurons. Respir Physiol 39:73–94, 1980
Wahba WM, Don HF, Craig DB: Postoperative epidural analgesia: effects on lung volumes. Canad Anaesth Soc J 22:519–527, 1975
Hendolin H, Lahtinen J, Lansimies E, Tuppurainen T, Partanen K: The effect of thoracic epidural analgesia on repiratory function after cholecystectomy. Acta Anaesthesiol Scand 31:645–651, 1987
Lund C, Hansen OB, Mogensen T, Kehlet H: Effect of thoracic epidural bupivacaine on somatosensory evoked potentials after dermatomal stimulation. Anesth Analg 66:731–734, 1987
Takasaki M, Takahashi T: Respiratory function during cervical and thoracic extradural analgesia in patients with normal lungs. Br J Anaesth 52:1271–1276, 1980
Renck H, Edstrom H, Kinnberger B, Brandt G: Thoracic epidural analgesia-II: prolongation in the early postoperative period by continuous injection of 1.0% bupivacaine. Acta Anaesth Scand 20:47–56, 1976
Hjortso NC, Lund C, Mogensen T, Bigler D, Kehlet H: Epidural morphine improves pain relief and maintains sensory analgesia during continuous epidural bupivacaine after abdominal surgery. Anesth Analg 65:1033–1036, 1986
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Sakura, S., Yanagidani, T., Saito, Y. et al. Changes in pulmonary function during continuous epidural bupivacaine with or without morphine following upper abdominal surgery. J Anesth 4, 319–326 (1990). https://doi.org/10.1007/s0054000040319
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DOI: https://doi.org/10.1007/s0054000040319