Enhanced pain management for post-gastrectomy patients with combined epidural morphine and fentanyl

Abstract

Purpose: To determine whether dinical advantages could be demonstrated by epidural fentanyl given in addition to epidural morphine for postEastrectomy analgesia.Methods: One-hundred and twenty two patients undergoing elective gastrectomy were prospectively studied in a randomised, double-blind fashion. All patients received epiduraJ lidocaine 1.5% with epinephrine (I :200,000) followed by light general anaesthesia for surgical anaesthesia. They were assigned to four groups according to the combinations of each epidural opioid: 2 mg morphine alone, 2 mg morphine + 100/Jg fentanyl, 4 mg morphine alone, and 4 rng morphine + 100 ~g fentanyl. Morphine and fentanyt were given epiduraUy approximately 60 and 15 min, respectively, before the completion of surgery. Results: Addition of epidural fentanyt to both doses of morphine not only decreased intensity of pain associated with coughing during the early postoperative period, but also prolonged the time until the first analgesic request at each morphine dose studied. Of the combination doses, 4 mg morphine + 100/2g fentanyl provided the longest time to the first request for analgesic, and was associated with least amount of postoperative analgesic supplement and best patient satisfaction without increasing incidence of side effects. C_x)ndusion: The addition of 100/2g fentanyl to 2 mg or 4 mg epidural morphine provides clinical advantages over morphine alone for post-Eastrectomy analgesia.Objectif: DEterminer s'il est diniquement avantageux d'ajouter du fentanyt ~ la morphine 6pidurale pour procurer I'analg6sie aprEs une gastrectomie. S~'thodes : Cent vingt-deux patients programm6s pour une gastrectomie non urgente ont particip~ ~ cette 6tude al(~atoire en double aveugle. Pour rintervention, tousles patients ont re(;u une ~pidurale ~-la lidocaine 1,596 adr6nalin6e (1:200,000) suivie d'une anesth~sie g~nErale I~g~re. Les patients ~taient r6partis en quatre groupes d6termin6s par le mode d'administration des morphiniques : morphine seule 2 rag, morphine 2 mg + fentanyt 100/Jg, morphine 4 mg seule, et morphine 4 mg + fentanyt 100/Jg. La morphine et le fentanyl ont ~td administr6s par la voie Epidurale environ 60 et 15 min avant la completion de la chirurgie. II.&mltats : Non seulement rajout de fentanyl ~pidural aux deux doses de morphine diminualt I'intensitE de la douleur associ6e ~ la toux de la p6riode postop~ratoire imm6diate mals prolongeait de plus I'intervalle pr6c~dant la premiere demande d'analg6sique avec chacune des doses de morphine. Cette prolongation ~talt la plus marqu6e avec morphine 4 mg + fentanyl 100 gg. Cette demi~re combinalson est celle qui n6cessit~ le moins de supplement analg6sique et procurait le plus haut deE6 de satisfaction chez le patient sans auEnenter les effets secondalres. ConcluiJon : II est diniquement avanta~ux d'ajouter du fentanyl ~ la morphine ~pidurale pour ranalgEsie apr~ une gastrectomie.

Cardiorespiratory effects of epidural administration of morphine and fentanyl in dogs anesthetized with sevoflurane

“…a combination of morphine and fentanyl could potentially shorten the onset of analgesia and enhance the analgesic effect. 1,8,9 In general, because opioids are considered to not induce significant sympathetic blockade following epidural adminsitration, 6,7 one would expect epidural administration of a combination of morphine and fentanyl to have few clinically important cardiovascular effects. However, decreases in mean arterial blood pressure and heart rate (HR) and an increase in PaCO 2 have been observed following epidural administration of fentanyl in cats anesthetized with isoflurane.…”