Comparison of Epidural Buprenorphine and Morphine for Postoperative Pain Control in Combined Spinal Epidural Anesthesia for Cesarean Section

Kim, Woon Young

Abstract

BACKGROUND: Combined spinal epidural anesthesia has become the technique of anesthesia for cesarean section because of the reliability of spinal block with the flexibility of epidural block. Buprenorphine, a new synthetic thebaine derivative is a partial agonist of the opioid micro-receptor with high receptor affinity, great lipid solubility, and slow rate of opiate receptor association and dissociation. Continous epidural infusion of opioid can possibly produced undesirable effects, such as respiratory depression, pruritus, etc.
METHODS
The present study was undertaken to compare the analgesic properties and side effects of continous epidural infusion of buprenorphine and morphine combined with bupivacaine in 60 patients following elective cesarean section in combined spinal epidural anesthesia. At the clothing of peritoneum, the initial bolus doses were 3 mg morphine (M group), 0.15 mg buprenorphine (0.15B group), 0.3 mg buprenorphine (0.3B Group) combined with 0.15% bupivacaine 10 ml and subsequent continous infusion doses were 6 mg morphine plus 0.125% bupivacaine 100 ml (M Group) and 0.6 mg buprenorphine plus 0.125% bupivacaine 100 ml (0.15B, 0.3B Group) during 48 hours. The assessment of analgesic efficacy and side effects were made at arrival of recovery room,postoperative 1, 4, 8, 24, 36, and 48 hours.
RESULTS
The pain score during 48 hours was significantly higher in the 0.15B group than in the M group and 0.3B group except the pain score of recovery room. (p<0.05) and the number of patients requiring additional analgesics was higher in 0.15B group than in the M group and 0.3B group but, it was not significant. The incidence of pruritus and urinary retention was significantly higher in M group than in the 0.15B and 0.3B group, and the incidence of sedation, nausea and vomiting was similar in three group. The subjective rating of satisfaction was better in the 0.3B group and M group than in the 0.15B group.
CONCLUSION
The above results suggest that continous epidural infusion of 0.6 mg buprenorphine after 0.3 mg buprenorphine initial bolus dose combined with low dose bupivacaine is an advisable method of postoperative pain control in combined spinal epidural anesthesia for cesarean section.