The Effect of Low Dose Bupivacaine on Epidural Morphine Analgesia for Postoperative Pian

경막외 몰핀 단독 투여와 국소마취제 혼주가 술후 진통 효과에 미치는 영향

  • Ha, Han-Soo (Department of Anesthesiology, St, Benedict Hospital) ;
  • Park, Yeong-Cheol (Department of Anesthesiology, St, Benedict Hospital) ;
  • Kim, Hae-Kyoo (Department of Anesthesiology, College of Medicine, Pusan National University) ;
  • Baik, Seong-Wan (Department of Anesthesiology, College of Medicine, Pusan National University) ;
  • Chung, Kyoo-Sub (Department of Anesthesiology, College of Medicine, Pusan National University)
  • 하한수 (부산성분도병원 마취과) ;
  • 박영철 (부산성분도병원 마취과) ;
  • 김해규 (부산대학교 의과대학 마취과학교실) ;
  • 백승완 (부산대학교 의과대학 마취과학교실) ;
  • 정규섭 (부산대학교 의과대학 마취과학교실)
  • Published : 1994.11.26

Abstract

Recently, epidural morphine has been administrated to decrease patients' systemic stress responses such as: suffers, endocrine responses and impairment of pulmonary function, etc. Epidural morphine provided excellent analgesic effect, but incomplete sensory blockade as compared to epidural local anesthetics, which has sympathetic blockade effect and tachyphylaxis. Therefore, the authors surmised that low dose bupivacaine on low dose epidural morphine improved postoperative pain with greater sensory analgesia than epidural morphine alone. The effect of low dose bupivacaine on epidural morphine analgesia for postoperative pain was evaluated in seventy patients. They were physical status I-III by ASA classification. Patients were randomly divided into 2 groups and they were administrated morphine 2.5 mg only (group I), morphine 2.5 mg plus 0.125% bupivacaine (group II) through epidural catheter 1 hour before the end of the operation. During postoperative second days, their analgesic effects were evaluated by visual analogue scale (0-10). Side effects were also evaluated. The results were as follows, 1) On the day of the operation, VAS score showed significant differences between two groups (morphine group $3.20{\pm}0.16$, morphine plus bupivacaine group $2.77{\pm}0.08$; p < 0.05). 2) On the postoperative and second day, there were no statistical differences between the groups according to VAS score. 3) The incidence of pruritus, nausea, and vomiting were no differences in both groups. 4) None of the patients showed objective sedation or a low respiratory rate (< 10 bpm). We concluded that epidural administration of low dose bupivacaine on the epidural morphine analgesia was an effective method to decrease postoperative pain with little change in frequencies of side effects compared to epidural morphine alone.

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