Morphine Plus Bupivacaine Vs. MorphinePeridural Analgesia in Abdominal Surgery:The Effects on Postoperative Coursein Major Hepatobiliary Surgery

摘要

Anaesthesia and surgical procedures lead to a reduction of intestinal motility, and opioids may produce a postoperative ileus, that might delay postoperative feeding. The aim of this prospective randomised study is to test whether or not different kinds of epidural analgesia (Group A: morphine 0.00 17 mg/kg/h and bupivacaine 0.125% – 0.058 mg/kg/h; Group B: morphine alone 0.035mg/kg/12h in the postoperative period) allow earlier postoperative enteral feeding, enhance intestinal motility a passage of flatus and help avoid complications, such as nausea, vomiting, ileus, diarrhoea, pneumonia or other infective diseases. We included in the study 60 patients (28 males and 32 females) with a mean age of 61.2 years (range 50–70) and with an ASA score of 2 or 3. All patients had hepato–biliary-pancreatic neoplasm and were candidates for major surgery.We compared two different pharmacological approaches,i.e., morphine plus bupivacaine (30 patients,Group A)versus morphine alone (30 patients,Group B). Each medication was administered bymeans of a thoracic epidural catheter for the controlof postoperative pain. In the postoperative coursewe recorded every 6 hours peristaltic activity. Wealso noted morbidity (pneumonia, wound sepsis)and mortality. Effective peristalsis was present inall patients in Group A within the first six postoperativehours; in Group B, after 30 hours. Sixpatients in Group A had bowel motions in the firstpostoperative day, 11 in the second day, 10 in thethird day and 3 in fourth day, while in Group B nonein the first day, two in the second, 7 in the third, 15in the fourth, and 6 in the fifth: the differencebetween the two groups was significant (P<0.05in 1st, 2nd, 4th and 5th days). Pneumonia occurredin 2 patients of Group A, and in 10 of Group B(P<0.05).We conclude that epidural analgesia with morphineplus bupivacaine allowed a move rapid returnto normal gut activity and early enteral nutrition comparedwith epidural analgesia with morphine alone.