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Epidural Morphine for Postoperative Pain: Experience with 1085 Patients
Author(s) -
STENSETH K.,
SELLEVOLD O.,
BREIVIK H.
Publication year - 1985
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.1985.tb02176.x
Subject(s) - medicine , anesthesia , nausea , vomiting , bupivacaine , thoracotomy , urinary retention , morphine , surgery , exploratory laparotomy
A prospective study of the effect and side‐effects of epidural morphine for pain relief in 1085 patients after thoracic, abdominal, urologic, or orthopaedic surgery was performed. Morphine chloride was diluted in saline or bupivacaine and administered through an epidural catheter placed at a segmental level appropriate for the type of surgery. The initial dose was 4 or 6 mg morphine and supplementary doses were given when needed to obtain complete freedom from pain during deep breathing or nursing care. The total dose of epidural morphine from end of surgery until the next morning varied from 4 to 18 mg. 97% of hip arthroplasty patients, 91% of prostatectomy patients and thoracotomy patients, 90% of patients after major lower extremity surgery and 88% of patients after laparotomy were completely satisfied with the postoperativr course. For hip arthroplasty and major extremity surgery, an initial dose of 4 mg of epidural morphine was as effective as 6 mg. After prostatectomy, laparotomy, and thoracotomy, an initial dose of 6 mg gave significantly better effect than 4 mg. Pruritus occurred in 11%, nausea or vomiting in 34%, and respiratory depression in 0.9% of the total patient population. Urinary retention occurred in 42% of patients not having urinary catheters in place. Postoperative nausea or vomiting was more frrquent in women than in men ( P <0.001). There was a higher incidence of nausea or vomiting in men experiencing pain than in men who were completely pain‐free after abdominal surgery ( P <0.001). Respiratory depression was rare and occurred as a gradually decreasing respiratory rate. Treatment with naloxone was effective without pain‐breakthrough. Naloxone relieved pruritus in 9O% of patients in whom it was attempted, but was not effective in treating nausea, vomiting, or urinary retention. After this study our dosage regimen for postoperative epidural morphine is: for major surgery of the lower limb or hip arthroplasty 4 mg; after prostatectomy. laparotomy, and thoracotomy 6 mg. No later than 12 h before the patients leave the postoperative care unit, half the initial dose of epidural morphine is usually repeated. Morphine is diluted in bupivacaine if pain is already present, otherwise in saline.