This study was designed to compare the efficacy of epidural analgesia using morphine or continuous infusion of bupivacaine and fen tanyl to IV morphine for postoperative analgesia after major abdominal surgeries in obese/morbid obese patients. Patients & Methods: The study included 45 obese patients with body mass index (BMI) >30 and assigned to undergo elective abdominal surgeries under general inhalational anesthesia. Patients were ramhnnly divided into 2 groups: IV group (n=15) assigned to receive postoperative IV morphine and epidural group which was further subdivided into M group treated with intermittent doses of epidural morphine and BF group received continuous infusions of bupivacaine I mg/nil combined with fentanyl 3 ug/ml. Postoperative pain was defined as a score on a visual analogue scale (VAS) front 0 to 5. Patients in IV group received IV boluses of 2.5-5 mg of morphine every ten minutes until they were comfortable, then, 5 mg morphine on request. Patients in group M received 5 mg of morphine via the epidural catheter one hour prior to the end of surgery and subsequent boluses of 3-4 mgAS hours. In group BF, patients received 10-15 »d bolus of the mixture followed by a constant infusion at a rate of 6-15 n4/hr. Both analgesia protocols were maintained for at least 48-hr after surgery. Patients' charts were analyzed for age, sex, BMI, co-morbid diseases, the duration of surgery, time in the operating room (OR), the length of the patients' stay in the postanesthesia care unit (PACU) and in hospital. VAS scores were recorded twice a day, when the patients were resting. Results : Patients in epidural groups spent significantly longer OR time but time till the passage of the first flatus was significantly (p=0.004) shorter in patients received epidural analgesia. Mean hospital stay was. nonsignificantly (p>0.05) shorter in epidural groups compared to IV group with, a non-significant (p>0.(W difference between both epidural groups. During the immediate postoperative period (at PM) patients or group had significantly lower VAS sthres compared both to IV group. (p=0.008) and to M group (p=0.017)and showed better analgesia with significantly lower VAS scores compared to scores determined in IV group throughout the 48-hr follow-up. Postoperative nausea and vomiting (PONV) occurred in 6 patients (40% Fin IV group, ill 4 patients (26.7%) in M group and in only 2 patients (13.3%) in BF group. Pruritus inis encountered in 3 patients (20%) in IV group, in 4 patients 06.7%) in M group and in only 2 patients (13,3%) in BF group. Wound infection was reported in 9 patients; 3 in IV group and 6 in epidural group. Conclusion : It could be concluded that continuous bupivacaineffentanyl epidural analgesia is an appropriate strategy for pain management during the postoperative period of obese/morbidly obese patients unditgoing major abdominal surgery with minimal side effects. |
