Effects of epidural bupivacaine and epidural morphine on bowel function and pain after hysterectomy

Publisher Website
Google Scholar
Abstract
A comparison was made of the effects of continuous epidural analgesia with bupivacaine and intermittent epidural morphine on bowel function after abdominal hysterectomy. The duration of postoperative ileus was assessed as the time from the end of operation to the first postoperative passage of flatus and feces. Twenty-two patients were randomly allocated to two equal groups. An "epidural morphine" group received general anesthesia and epidural morphine for postoperative pain relief, and an "epidural bupivacaine" group was given combined general anesthesia and epidural anesthesia with 0.5% bupivacaine intraoperatively and epidural analgesia with 0.25% bupivacaine postoperatively. Epidural morphine or bupivacaine was given for 42 h postoperatively. Pain intensity (visual analog scale) was low in both groups, but lowre (P < 0.005) in the epidural bupivacaine group. The tiem to first passage of flatus was 22 .+-. 16 h in the epidural bupivacaine group and 56 .+-. 22 h in the epidural morphine group (P < 0.001). The tiem to first postoperative passage of feces was shorter (P < 0.05) in the former than in the latter (57 .+-. 44 h vs 92 .+-. 22 h). The patients of the epidural bupivacaine group started intake of oral fluids earlier (P < 0.01) and to a greater extent (P < 0.04) than those in the epidural morphine group. It is concluded that the duration of postoperative ileus after hysterectomy is shorter when epidural bupivacaine is given for postoperative pain relief than when this is achieved by epidural morphine.