Patient-controlled epidural analgesia with morphine in renal transplant patients

Abstract

WITH THE INCREASING use of epidural anesthesia for renal transplantation surgery, epidural analgesia might become an alternative choice for postoperative pain management in transplant patients. The aim of this study was to evaluate the use of patient-controlled epidural analgesia with morphine and to compare two dose regimens in the early postoperative period. Twenty-seven patients with chronic renal failure undergoing transplantation received epidural anesthesia. Postoperatively, a patient-controlled analgesia (PCA) pump was connected to the patient and programmed to give either morphine boluses of 0.3 mg only with a 20-minute lockout time (group 1) or an additional infusion of morphine at a rate 0.3 mg/h (group 2), both using a 0.1-mg/mL concentration. Pain assessment was done using the NRS (numerical rating scale) and patients were compared with respect to bolus and total doses of morphine, demand:delivery ratio, side effects (nausea and vomiting, pruritis, hypotension), and the hemodynamic status (mean blood pressure, heart rate). Patients’ characteristics in the groups were similar. In both groups, demand and delivery doses were comparable, but the total dose of morphine was significantly higher in the second group (P 5 .0005, P , .05). Eight of the patients in group 1 and five in group 2 developed pruritis; seven and four, respectively, had nausea and vomiting, but there was no significant difference between the groups with regard to frequency of side effects (P . .05). None of the patients became hypotensive and hemodynamic status was similar in both groups (P . .05). In conclusion, epidural PCA with morphine as a bolus dose of 0.3 mg without basal infusion is sufficient for pain management following renal transplantation. Continuous epidural anesthesia for renal transplantation has been used for the last decade. Postoperative epidural analgesia has also been used in these patients during this same period of time, but only rarely. Hence, the search for appropriate agents and doses will continue to be the subject of future studies. We compared the effects of postoperative patient-controlled epidural analgesia (PCEA) with two morphine dosing regimens following renal transplantation. PATIENTS AND METHODS