Korean J Anesthesiol.  2004 May;46(5):560-564. 10.4097/kjae.2004.46.5.560.

A Comparison of Epidural Morphine-Bupivacaine with Intravenous Morphine-Ketorolac in Patient-Controlled Analgesia after Gynecologic Operation

• Suh JH
• Park KS
• Yun JY
• Do SH

• KMID: 2091820
• DOI: http://doi.org/10.4097/kjae.2004.46.5.560

Abstract

BACKGROUND
Postoperative pain control is provided for humanitarian reasons and to alleviate nociception-induced responses, such as endocrine metabolic responses, autonomic reflexes, which have adverse effects on organ function, and other undesirable results. Of the various methods of treatment, patient-controlled analgesia (PCA) is considered the gold standard for the of control postoperative pain. PCA can be administered via intraveous, epidural, or subcutaneous routes. Although patient-controlled epidural analgesia (PCEA) has been compared to IV-PCA, there is no optimal administrative route for the treatment of postoperative pain. This randomized study compared the effectiveness of PCEA and IV-PCA on postoperative pain and the side-effects after gynecologic surgery.
METHODS
Ninety-seven patients undergoing gynecologic surgery were randomly assigned to receive either IV-PCA using a mixture of morphine and ketorolac or PCEA using 0.1% bupivacaine and morphine. Pain intensity was tested using a visual analog scale (VAS) until postoperative day 2. Nausea, vomiting, sedation, and pruritus were also measured.
RESULTS
Among the 97 patients, 12 patients were excluded during study. Pain relief was better at rest and after coughing in the PCEA group during the 2 postoperative days, except at the first visit. Additional analgesics were used significantly less in the PCEA group, whilst the incidence of other complications was comparable in the IV-PCA and PCEA groups.
CONCLUSIONS
After gynecologic surgery, PCEA using bupivacaine and morphine provides better pain relief than IV-PCA using morphine and ketorolac.

Keyword

bupivacaine; ketorolac; morphine; patient-controlled analgesia

MeSH Terms

Analgesia, Epidural
Analgesia, Patient-Controlled*
Analgesics
Bupivacaine
Cough
Female
Gynecologic Surgical Procedures
Humans
Incidence
Ketorolac
Morphine
Nausea
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Pruritus
Reflex
Visual Analog Scale
Vomiting
Analgesics
Bupivacaine
Ketorolac
Morphine