Korean J Anesthesiol.  2005 Apr;48(4):393-397. 10.4097/kjae.2005.48.4.393.

A Comparison of Patient Controlled Epidural Analgesia after Subtotal Gastrectomy

• Baek SH
• Yoon JU
• Shin SW
• Kwon JY
• Kim HK
• Baik SW

• KMID: 2032233
• DOI: http://doi.org/10.4097/kjae.2005.48.4.393

Abstract

BACKGROUND: Local anesthetics and opioids have been widely used for epidural patient controlled analgesia (PCEA). Epinephrine also has been known to potentiate the analgesic effect of epidurally administered local anesthetics or opioids. The aim of this study was to compare analgesic effects and side effects of PCEA with ropivacaine mixed with either morphine, fentanyl, or epinephrine.
METHODS
Sixty-seven subtotal gastrectomy patients with postoperative analgesia by PCEA were randomly allocated into group M; 0.2% ropivacaine and 40microgram/ml morphine, group F; 0.2% ropivacaine and 4microgram/ml fentanyl, or group E; 0.2% ropivacaine and 2microgram/ml epinephrine. The visual analogue scale (VAS) for pain and side effects at 6 and 24 hours postoperatively were measured.
RESULTS
The VAS scores were significantly higher in group E compared to group M and F at 6 hours postoperatively and to group F at 24 hours postoperatively. The total doses of PCEA in M group were lower than those of F and E groups. The incidence and severity of postoperative nausea were higher in group M compared to group F, E at 6 and 24 hours postoperatively.
CONCLUSIONS
Epinephrine provided lesser side effects and higher VAS score compared to fentanyl or morphine mixed with ropivacaine PCEA. Epinephrine instead of opioids may be used for PECA without significant side effects, however the dose adjustment of PCEA may be needed for adequate analgesia.

Keyword

epidural analgesia; epinephrine; fentanyl; morphine; patient controlled analgesia

MeSH Terms

Analgesia
Analgesia, Epidural*
Analgesia, Patient-Controlled
Analgesics, Opioid
Anesthetics, Local
Epinephrine
Fentanyl
Gastrectomy*
Humans
Incidence
Morphine
Postoperative Nausea and Vomiting
Analgesics, Opioid
Anesthetics, Local
Epinephrine
Fentanyl
Morphine