Patient-controlled analgesia with epidural pethidine or buprenorphine plus bupivacaine for postoperative analgesia
Mitsuhata, H.; Hirabayashi, Y.; Saitoh, K.; Horiguchi, Y.; Togashi, H.; Shimizu, R.; Hasegawa, J.; Matsumoto, S.
Masui. Japanese Journal of Anesthesiology 42(11): 1623-1627
1993
ISSN/ISBN: 0021-4892 PMID: 8254871 Document Number: 409394
We evaluated the efficacy of epidural patient-controlled analgesia (PCA) with pethidine or buprenorphine plus 0.25% bupivacaine for postoperative analgesia after laparotomy with a midline incision under general anesthesia. Twenty patients were randomly allocated to two groups. In one group (PCEA-P group; n=10), epidural pethidine plus 0.25% bupivacaine by PCA with 5 mg of pethidine and 2.5 ml of 0.25% bupivacaine bolus with a lockout interval of 20 min was added to a continuous epidural infusion of 0.25% bupivacaine (2 ml cntdot h-1) plus pethidine (100 mg cntdot 24 h-1) for 72 h. In the other group (PCEA-B group; n=10), epidural buprenorphine plus 0.25% bupivacaine by PCA with 0.03 mg of buprenorphine and 2.5 ml of 0.25% bupivacaine bolus with a lockout interval of 20 min was added to a continuous epidural infusion of 0.25% bupivacaine (2 ml cntdot h-1) and buprenorphine (0.6 mg cntdot 24 h-1) for 72 h. Analgesia was evaluated by 100 mm visual analog scale and verbal descriptor scale. In PCEA-B group, 90 % of the patients did not complain of pain at rest, and in PCEA-P group, all the patients did not complain of pain at rest for 72 h. There were no significantly different analgesic effects between PCEA-P and PCEA-B for 48 h. The average doses of epidural PCA were 1.9 mg cntdot kg-1 cntdot 24 h-1 of pethidine, and 0.012 mg cntdot kg-1 cntdot 24 h-1 of buprenorphine, respectively. We conclude that PCEA-P and PCEA-B were effective for postoperative pain to the same degree for the first 48 h, but PCEA-P was superior to PCEA-B for the last 24 h.