RELIEF OF POSTSURGICAL PAIN BY PATIENT CONTROLLED EPIDURAL ANALGESIA WITH THREE DIFFERENT DRUG REGIMENS

Abstract

S312 The aim of this study was to compare the analgesic efficacy of patient controlled epidural analgesia (PCEA) with three different medication combinations in the relief of postoperative pain. METHODS: After giving their consents 120 adult patients of physical status ASA I and II who were scheduled for elective abdominal surgeries were enrolled into this study. All patients received epidural anesthesia with 2% lidocaine. At the completion of surgery patients were divided equally into 3 groups by double-blind, randomized design with administration through indwelling epidural catheter of one of the following 3 medications: Group F received a mixture of fentanyl 4 mcg/ml of 0.15% bupivacaine; Group BF received fentanyl 4 mcg+buprenorphine 9 mcg/ml of 0.15% bupivacaine; Group MF received fentanyl 4 mcg+morphine 50 mcg/ml of 0.15% bupivacaine. The epidural catheter was attached to a Graseby-9300 PCA pump. All patients received a loading dose of 5 ml of the respective solution, followed by 1 ml/hr continuous infusion plus PRN bolus dose of 1 ml with a lock-out interval of 20 minutes. Vital signs, pain intensity by VAS evaluation, frequency and dose of PCEA, incidence of adverse effects were recorded for 24 hour postoperatively. RESULTS: The demographic data were comparable for all 3 groups. Both Group BF and MF showed significantly less frequent PCEA doses being activated by the patients, less total dose of drug solution being used, and lower VAS score than those of Group F. Incidence of nausea/vomiting were very low and similar for all 3 groups, and no pruritis or respiratory depression was observed in any of the patients. Both Group BF and MF showed higher incidence of drowsiness than that of Group F (Table 1).Table 1: Incidence of Adverse Effects (expressed by %)CONCLUSION: Our study showed that PCEA with fentanyl/bupivacaine provided effective and safe analgesia to patients with postoperative pain after abdominal surgery. Addition of small dose of buprenorphine or morphine to the fentanyl/bupivacaine solution appeared to enhance its analgesic efficacy without significant adverse effects.