CONTINUOUS EPIDURAL INFUSION OF MORPHINE FOR TREATMENT OF PAIN AFTER THORACIC-SURGERY - A NEW TECHNIQUE

  • 1 January 1984
    • journal article
    • research article
    • Vol. 63  (8) , 757-764
Abstract
Postoperative pain relief and the incidence of side effects of 3 methods of thoracic epidural analgesia were evaluated. Patients (90) divided into 3 equal groups, received postoperative analgesia after thoracic surgery either as intermittent epidural injections of bupivacaine (25 mg/5 ml, 0.5% solution) as needed, or, intermittent epidural injections of morphine (5 mg/5 ml of normal saline, 0.1% solution) as needed, or continuous epidural infusion of morphine (0.1 mg, in 1 ml of normal saline) per h supplemented with i.v. morphine (2 mg) upon request. Pain relief was evaluated by each patient on a pain visual analog scale and by pain relief questionnaire for a period of 72 h. Postoperative pain relief was achieved equally with these 3 methods of epidural analgesia in all patients with no significant difference between groups. Intermittent epidural injection of bupivacaine relieved pain for 4.9 .+-. 1.9 h/injection and was associated with urinary retention in all patients, with numbness and weakness of the hands in 12 patients, and with severe hypotension in 7 patients. Intermittent epidural injection of morphine relieved pain for 5.8 .+-. 2.3 h injection and was associated with urinary retention in all patients, with pruritus in 12 patients, and with central narcosis and respiratory depression in 8 patients. Continuous epidural infusion of morphine with occasional i.v. morphine (2 mg) supplementation also effectively relieved postoperative pain and was associated with minimal systemic side effects. One patient complained of pruritus, and 2 patients developed urinary retention. Continuous epidural infusion of morphine at 0.1 mg/h achieves effective and selective pain relief in the majority of patients after thoracic operations. Although this method of pain relief requires occasional supplementation with systemic narcotics, this technique avoids the major systemic side effects of both intermittent epidural injections of larger doses of morphine and those associated with epidural injection of bupivacaine.