Effects of epidural morphine and epiduralo bupivacaine on gastroduodenal motility during the fasted state and after food intake

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Abstract
The effects of a thoracic epidural analgesia with morphine or bupivacaine on gastroduodenal motility during the fasted state and after food intake were evaluated in healthy volunteers. Nine volunteers were studied on two occasions, separated by at least 2 weeks, and were randomly allocated to receive either epidural morphine or epidural bupivacaine at the T6–T7 level on each occasion. Gastroduodenal motility was measured by manometry. Acetaminophen absorption was used as an indirect measure of the rate of gastric emptying and orocecal transit time was determined by use of the hydrogen breath test after ingestion of raffinose. During the control measurements, before the epidural analgesia, there were no differences in gastroduodenal pressure activity between the morphine and bupivacaine groups. Compared to epidural bupivacaine, epidural morphine significantly changed the pressure activity with a higher number of contractions in the duodenum, both during the fasted state and after food intake. Retrograde pressure activity was seen in the duodenum after epidural morphine but not after epidural bupivacaine. There were no significant differences in the pressure activity in the stomach after epidural morphine compared to epidural bupivacaine. Gastric emptying was delayed and orocecal transit time prolonged after epidural morphine. This study in volunteers showed that epidural morphine, compared to epidural bupivacaine, significantly changed the gastroduodenal motility, both during the fasted state and after food intake.