The effect of bupivacaine and morphine on pain and bowel function after colonic surgery

Abstract

Sixty patients scheduled for colonic surgery were randomly allocated to four groups according to postoperative pain medication: I. Control group, the patients received oxycodone intramuscularly (0.15 mg kg-1) on request. II. Epidural bupivacaine (0.25%) continuously administered by infusion pump, 4-6 ml h-1, for 48 h. III. Epidural morphine, 2-6 mg, at the end of operation and repeated on the first and second postoperative mornings. IV. Epidural morphine, 2-6 mg per die, administered for 48 h continuously by infusion pump. All patients received a balanced anaesthesia with enflurane, fentanyl and vecuronium. Postoperatively, intramuscular oxycodone was given on request. There were no significant differences between the groups in changes in peak flow, spirometry and blood-gas analyses postoperatively. Pain intensity (visual analogue scale) was lower in Groups II and III at 3 h and in Group IV at 24 h compared to the control Group I. All the epidurally treated groups needed less additional analgesics than the control Group I. Postoperatively bowel movements occurred on the second day in Group II (bupivacaine) as compared to the fourth day in all other groups (P less than 0.05).

Epidural naloxone reduces intestinal hypomotility but not analgesia of epidural morphine

“…Epidural morphine has a negative effect on the recovery of intestinal motility. [16][17][18][19] We found the time to the first postoperative passage of flatus and feces after surgery was reduced in the experimental group that was given the antagonist. We believe that the use of epidural naloxone antagonized the morphine-induced intestinal hypomotility and infer from this that the intestinal hypomotility from morphine is mediated by both central and systemic receptor level, 2 0 and that this mechanism can be prevented by epidural administration of naloxone.…”

Two Different Epidural Analgesic Combinations: Morphine vs. Fentanyl/Bupivacaine or Fentanyl/Ropivacaine and Their Post Operative Effects

“…This stress response (increased heart rate, blood pressure, etc.) has many negative effects including postoperative ileus and cardiac ischemia in susceptible individuals (Scheinin & Orko, 1987). Pain is well known to contribute to improper postoperative coughing and deep breathing exercises, which predispose patients to pulmonary complications.…”

Morphine Plus Bupivacaine Vs. MorphinePeridural Analgesia in Abdominal Surgery:The Effects on Postoperative Coursein Major Hepatobiliary Surgery

“…Effective peristalsis was present in all patients in Group A within the first six postoperative hours; in Group B, after 30 hours. Six patients in Group A had bowel motions in the first postoperative day, 11 in the second day, 10 in the third day and 3 in fourth day, while in Group B none in the first day, two in the second, 7 in the third, 15 in the fourth, and 6 in the fifth: the difference between the two groups was significant (p<0.05 in 1st, 2nd, 4th and 5th days). Pneumonia occurred in 2 patients of Group A, and in 10 of Group B (p < 0.O5).…”

“…Such reflex is carried partly by afferent pain fibers and plays a role in curtailing blood flow and in reducing peristaltic activity. Control of postoperative pain gives thus an important contribution to the return of gut activity [2,10].…”