Abstract
Abstract: These investigations were undertaken to study the effects of epidural analgesia with morphine and bupivacaine on gastrointestinal motility and to evaluate if the effect of morphine after epidural administration is a central or peripheral effect. Comparative studies were performed in volunteers, postoperative patients and pigs. Gastroduodenal motility was evaluated by manometry, electromyography (EMG) and external electro‐gastrography (EGG). Gastric emptying was studied by an absorption test (acetaminophen) and orocecal transit time by the hydrogen breath test after ingestion of raffinose. In one study, intrathecal and intramuscular morphine were given simultaneously in an effort to receive plasma concentration of morphine comparable to that after an epidural administration. This combination was compared with intrathecal morphine alone to evaluate if the gastrointestinal effects were mediated by central or peripheral mechanisms.Epidural morphine delayed gastric emptying in healthy volunteers and in postoperative patients. Thoracic epidural bupivacaine with sensory block of the dermatomes T3‐T12 did not influence gastric emptying. Orocecal transit time was prolonged after epidural morphine compared to epidural bupivacaine. Duodenal contractile activity was significantly increased in volunteers after epidural morphine compared to epidural bupivacaine. The pressure activity seen after epidural morphine was not always propulsive and retrograde activity occurred frequently. Gastric activity measured by EMG and EGG was significantly disturbed after intrathecal and epidural morphine and tachygastria was frequently seen. Intramuscular administration of morphine during intrathecal morphine resulted in additive effects.These studies have shown that epidural morphine compared to epidural bupivacaine delays gastric emptying and prolongs orocecal transit time. These effects may be explained by the disturbed gastroduodenal motility seen after epidural morphine. The gastroduodenal effects of epidural morphine may be caused by both a central and a systemic effect of morphine.
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