Recent studies have shown that epidural administration of morphine and/or bupivacaine produce an unusually intense, prolonged and segmental analgesic action for patients with acute or chronic pain including postoperative pain and cancer pain
We undertook a prospective study to assess the postoperative analgesic effect, side effects, and the effect on postoperative recovery of continuous epidural analgesia in patients underwent upper abdominal surgery and modified radical mastectomy
for
breast cancer. The epidural group 9n=50) received continuous epidural analgesia with morphine and bupivacaine postoperatively for 16~92 hours (70.54±17.95 hours: mean±SD) and the control group(n=50) received intermittent injection of analgesics
such
as Pethidine HCl and Nalbuphine HCl for postoperative pain relief.
Postoperative analgesic efficacy was assessed by the pateitns. In the epidural group, the degree of satisfaction on analgesic effect showed excellent in 62% and good in 22% of the patients which was significantly superior to that of control group
(p<0.001). The time for first oral intake, the incidence of postoperative pulmonary complications and the duration of hospital stay did not show statistical difference between the two groups. However, we thought that epidural analgesia allows
pateints
to breathe more easily cough better walk sooner, and exccrcise better aftr upper abdominal and breast surgery, and it may paly a role in improving gastrointestinal motility and reducing the incidence of pulmonary complications.
There were several side effects of epidural morphine such as nausea and vomiting (8%), pruritus (16%), urinary retention (16%), and dizziness (2%), Most of them were not significant in severity and managed easily with conservative measure or
subsided
spontaneously.
In conclusion, epidural analgesia with the combination of morophine and bupivacaine is safe and effective means of prolonged and segmental postoperative analgesia in patients underwent upper abdominal surgery and modified radical mastectomy for
breast
cancer. and it produces pain relief superior to that provided by traditional systemic administration of narcotics.
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