Comparison of Continuous Epidural Infusion of Fentanyl-Bupivacaine and Morphine-Bupivacaine in Management of Postoperative Pain

Abstract

RJ, IVANKOVICH AD. Comparison of continuous epidural infusion of fentanyl-bupivacaine and morphine-bupivacaine in management of postoperative pain. Anesth Analg 1988;67:559-63.The short duration of epidural fentanyl has limited its direct comparison with epidural morphine in previous reports. The following study was performed of continuous postoperative epidural infusions at 5 mllhr fentanyl 10 pglml (n = 59) or morphine 0.1 mglml (n = 48), both with bupivacaine 0.1 %, in patients having cesarean sections. Postoperative evaluations included the frequency and magnitude of clinically evident respiratory depression, the adequacy of analgesia, nausea, pruritis, the ability to ambulate, and other side effects for 24 hours. Analgesia and the number of supplemental narcotic injections needed were similar in both groups. The incidence of nausea and pruritis was significantly less in the patients receiving fentanyl. No patient developed respiratory depression in either group. Patient and staff acceptance of the continuous epidural technique was excellent because there were only minor catheter-related problems associated with its use. It is concluded that continuous epidural fentanyl combined with bupivacaine offers excellent postoperative analgesia with minimal side effects.

Superficial Dorsal Horn Neurons Identified by Intracutaneous Histamine: Chemonociceptive Responses and Modulation by Morphine

“…Pruritis is a common side-effect of epidural or IT opiates (see INTRODUCTION) and is more common with morphine compared with more lipophilic opioids such as fentanyl (Ballantyne et al 1988;Fischer et al 1988). In the present study, low concentrations of IT morphine resulted in facilitation of the responses of a substantial fraction of superficial dorsal horn units to ic histamine or noxious heat, although their spontaneous activity did not increase significantly.…”

“…Itch is said to rarely coexist with pain, and noxious stimuli inhibit itch (Graham et al 1951;Greaves and Wall 1996;McMahon and Koltzenburg 1992;Ward et al 1996). Furthermore, administration of opiates by systemic, epidural, or intrathecal (IT) routes reduces pain but often elicits itching (Brennum et al 1993;Bromage et al 1982a;Fischer et al 1988;Hales 1980; for reviews see Ballantyne et al 1988;Bromage 1981;Morgan 1987). Microneurographic studies have revealed that intraneural electrical microstimulation near the axon(s) of polymodal nociceptors elicits a sensation of pain that increases in intensity with increasing stimulus frequency, but does not change to itch at lower frequencies (Ochoa and Torebjork 1989).…”

Considerações sobre analgesia controlada pelo paciente em hospital universitário

“…In evaluating analgesics and their respective routes, from the 368 cases where morphine was used, 342 (92.93%) were e p i d u r a l l y i n j e c t e d . T h i s c h o i c e w a s d u e t o t h e hydrosolubility of this agent, as previously explained, and the association of local anesthetics was mandatory to benefit the most of the analgesic potential by the synergy between both drugs 37,38 . Methadone, another potent opioid recommended by the WHO for chronic pain does not have a pharmacological profile to be used in PCA due to its characteristic cumulative effect and prolonged half-life 39 .…”

“…Esta característica físico-química lhe confere o poder de, uma vez utilizada no espaço peridural, alcançar altas concentrações próximo ao seu local de ação, sem atingir significativas concentrações plasmáticas[33][34][35] . sinergismo entre estas duas drogas37,38 . A metadona, outro opióide potente recomendado com freqüência pela OMS em situações de dor crônica, não apresenta perfil farmacológico que a torne um agente a ser empregado em ACP, pelo seu característico efeito cumulativo e sua meia-vida prolongada39 .…”

Continuous epidural analgesia with bupivacaine‐fentanyl versus patient‐controlled analgesia with i.v. morphine for postoperative pain relief after knee ligament surgery Note

“…If local anaesthetics alone are used, sufficient pain relief tends to cause too extensive motor block. To avoid this, a combination of a small concentration of bupivacaine and opioid has been recommended for epidural infusion for postoperative pain ( 1, 2). This mixture provides better pain relief than either drug alone, and the incidence of side effects is diminished.…”