We have compared the efficacy and side effects of extradural morphine with extradural fentanyl for postoperative pain relief. Thirty children (ages 1-16 yr) were allocated randomly to receive, after extradural administration of 0.5% bupivacaine 0.75 ml kg-1 and before surgical incision, extradural morphine 0.75 microgram kg-1 (group M), with an additional dose administered 24 h later or extradural fentanyl 2 micrograms kg-1 (group F) followed by a continuous extradural infusion (during 48 h). There was no major complication (respiratory depression). Pain scores were satisfactory in both groups for 48 h. Ventilatory frequency was greater in group M 20, 21, 22, 23 and 25 h after the beginning of analgesia (P < 0.05). Pruritus, nausea and vomiting were less common with extradural fentanyl (20% vs 53%, P < 0.05 and 0% vs 33%, P < 0.05) than with morphine. Urinary retention occurred with equal frequency (25%) in the two groups. After a bolus of 2 micrograms kg-1, continuous extradural infusion of fentanyl 5 micrograms kg-1 day-1 provided analgesia comparable to that from a daily bolus of extradural morphine 0.75 mg kg-1 and produced fewer side effects.
La place des techniques d'analgésie périmédullaire dépend grandement de l'expérience des équipes, mais cette méthode analgésique reste globalement insuffisamment pratiquée en France au regard de l'expérience étrangère ; pourtant un choix, voire une sélection rigoureuse des patients, une sélection des produits et des techniques permettent une prise en compte adéquate de nombreuses situations extrêmes tant en douleur cancéreuse que bénigne ; les risques sont connus, identifiés et en large partie prévisibles ; le problème reste toujours celui de l'expérience humaine, de la lourdeur de l'investissement par l'équipe de prise en charge et de difficultés administratives certaines.Abstract: The importance of invasive methods in the treatment of chronic and recurrent debilitating pain remains controversial. Epidural and inthrathecal techniques are offering viable options by providing patients with relief, particularly in the case of pain with multiple manifestations and causal mechanisms, whether resulting from cancers or non-malignant tumours. However, these techniques also require experience and expertise to be safe. They are associated with some risk, which must be assessed and might have economic ramifications. Therefore, it is clear that the decision to use these methods must be based on a rigorous protocol for selecting patients and deciding appropriate analgesics; this requires a truly multidisciplinary medical team. For this reason, these techniques are part of a vast therapeutic reserve we rely on conservatively. They do not offer the best solution, but they can and should contribute to relieving pain in many of these patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.