Postoperative Analgesia for Oesophageal Surgery: A Comparison of Three Analgesic Regimens

Abstract

Sixty-four patients undergoing oesophageal surgery were randomly allocated to receive either a continuous lumbar epidural infusion of morphine or fentanyl, or, intramuscular morphine for postoperative analgesia. There was no statistical difference in analgesic requirements between the patients who underwent a thoracotomy for their procedure (n = 50) and those who did not (n = 14), as assessed by the total dose of opioid administered, visual analogue scale (VAS) and pain score (PS) comparison. However, by these criteria, epidural morphine infusion provided the most satisfactory analgesia (P < 0.05). Despite the variable quality of analgesia achieved with the three regimens, the postoperative lung function tests were similar for all groups, and we conclude that routine lung function tests are not an appropriate method of comparing analgesic efficacy. Prophylactic administration of loratadine to 15% of our patients was not shown to be effective in diminishing the incidence of pruritus.

What Epidural Opioid Results in the Best Analgesia Outcomes and Fewest Side Effects After Surgery?

“…2). [24][25][26]28,31 Subgroup analysis by type of surgery significantly reduced the amount of heterogeneity at these time points (Fig. 3).…”

“…White et al 30 Figures and in-text Orthopedics 66 3 Tsui et al 31 Tables and in-text Abdominal and thoracic 35 2 Chrubasik et al 32 Tables, figures, and in-text Abdominal 40 3 Fischer et al 33 Figures and in-text C-section 105 4 Fentanyl vs sufentanil Jeon et al 34 Tables, figures, and in-text Orthopedics 37 2 Lutti et al 35 Tables and in-text Orthopedics 70 2 Wilhelm and Dieleman 36 Tables, figures, and in-text Abdominal and thoracic 53 4 Cohen et al 37 Tables, figures, and in-text C-section 250 4 Geller et al 38 Tables and in-text Abdominal 30 5 Morphine vs oxycodone Yanagidate and Dohi 39 Tables, figures, and in-text Abdominal 50 4 Backlund et al 40 …”

“…Two studies in this group were not pooled. First, we excluded the data from Tsui et al 31 because an antipruritic was randomly administered to all study subjects. Second, the study by Vallejo et al 25 was the only trial to report pruritus on a continuous scale, and no difference between the groups was detected.…”

Effect of epidural blockade on indicators of splanchnic perfusion and gut function in critically ill patients with peritonitis: a randomised comparison of epidural bupivacaine with systemic morphine

“…The opioid sparing component of epidural analgesia may also contribute, as may a possible systemic effect of local anaesthetic agents, which have been shown to reduce ileus [28]. These potential benefits have been investigated in many studies of surgical patients, where epidurals have been shown to produce superior analgesia [5], improved intestinal motility [16], shorter duration of ileus [29] and improved measures of pulmonary function [30]. When reviewed, however, it is apparent that the level and duration of blockade are of great importance in the efficacy of epidural regimens [31,32]; consequently it has been more difficult to demonstrate actual improvements in outcome [33].…”

“…There were no significant differences between the groups in any of the variables derived from the paracetamol absorption test (n = 10); both groups showed persistently delayed gastric outflow throughout the study period. Conclusions: Epidural analgesia resulted in improvements in gastric mucosal perfusion and the ultrasound appearance of the small bowel, indicating potential clinical benefit in a group of patients in whom epidural catheterisation is traditionally contraindicated Epidural administration of local anaesthetics and opioids, alone or in combination, is a well-established technique for the treatment of pain after laparotomy or thoracotomy, offering superior analgesia to conventional regimes [5]. There may be value therefore in administering epidural bupivacaine to patients with peritonitis in the intensive therapy unit (ITU) setting.…”