Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Management in Gynecologic Lower Abdominal Surgery

Lee, Hye Won; Kim, Jae Hwan; Lim, Hae Ja; Chae, Byoung Kuk; Shin, Jung Soon; Chang, Seong Ho

Abstract

In a double-blind randomized study of five groups of fifty patients scheduled for gynecologic lower abdominal surgery the analgesic efficacy and side effects of epidurai buprenorphine were tested and compared to epidural morphine. Single epidural injeetion of 0.15mg of buprenorphine in group B 0.15, 0.30 mg of buprenorphine in group B D.3, 0.45 mg of buprenorphine in group B 0.45, 3 mg of morphine in group M 3 or 6 mg of morphine in group M 6 mixed with 10 ml of normal saline was done when the patients complained of postoperative pain after general anesthesia with enflurane-N2O-O2. The results were as follows; 1) The onset of analgesia was the most rapid in group B 0.45(20.7+/-3.2 minutes), and appeared as following order: group M 6(29.3+/-14.3 minutes), group M 3(37.5+/-6.7 minutes), group B 0.3(39.3+/-8.7 minutes), and group B 0.15(60.7+/-20.2 minutes). 2) Additional requirement of analgesics during first 24 hours after epidural injection was more frequent in group B O.IS(70%) than in any other four groups. 3) The lowest pain score during 24 hours after epidural injection was the lowest in group M 6(1.6+/-0.5) and group B 0.45(1.8+/-0.4) and the increasing order of the lowest pain score were as follows; 2.2+/-0.4 in group M 3, 2.3+/-0.5 in group B 0.3 and 2.6+/-0.5 in group B 0.15. 4) The pain score measured 24 hours after epidural injection was significantly lower in group B 0.45(2.0+/-0.0) than in any other four groups. 5) Subjective rating of well-being for first 24 hours following epidural injection was better in group B 0.45(good in 60% of patients) than in group M 6(good in 10% of patients). 6) Subjective rating of sleep at the first postoperative night showed no significant differences among five groups. 7) Disturbance of micturition after removal of catheter was noted in group B 0.45 and group M 6(30% each) and spontaneous urination after removal of catheter was significantly delayed in group B 0.45(9.1+/-10.2 hours) and in group M 6(7.2+/-7.8 hours) comparing to other three groups. 8) Pruritus was noted only in the groups with epidural morphine(in group M 3 & M 6; 70% each) and there was no statistieal difference between group M 3 and group M 6. 9) The frequency of nausea or vomiting was the lowest in group B 0.45(30%) and the highest in group M 3(90%), and no significant differences were noted among other three groups. 10) Dizziness was noted in group B 0.45 and in group M 6(30% each), but there was no statistical significances among five groups. I I) No signs of respiratory depression were noted.