ABSTRACT
Purpose : This study was designed to compare the efficacy of epidural analgesia using morphine or continuous infusion ofbupivacaine and fentanyl to IV morphine for postoperative analgesia after major abdominal surgeries in obese/morbid obese patients.
Patients & Methods : Tlie study included 45 obese patients with body mass index (BMl) >30 and assigned to undergo elective abdominal surgeries under general inhalational anesthesia. Patients were randomly divided into 2 groups: IV group (n=15) assigned to receive postoperative IV morphine and epidural group which urns further subdivided into M group treated with intermittent doses of epidural morphine and BF group received continuous infusions ofbupivacaine 1 mg/rnl combined until fentanyl 3 ug/ml. Postoperative pain was defined as a score >2 on a visual analogue scale (VAS) from 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 receiiied 5 mg of morphine via the epidural catheter one hour prior to the end of surgery and subsequent boluses of 3-4 nig/8 hours. In group BF, patients received 10-15 ml bolus of the mixture followed by a constant infusion at a rate of 6-15 ml/lir. Both analgesia protocols were maintained for at least 48-hr after surgery. Patients' charts were analyzed for age, sex, BMl, 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, luhen 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 non-significantly (p>005) shorter in epidural groups compared to IV group with a non-significant (p>0.05) difference between both epidural groups. During the immediate postoperative period (at PM) patients in BF group had significantly lower VAS scores compared both to IV group (p=O.OOS) 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 folloio-up. Postoperative nausea and vomiting (PONV) occurred in 6 patients (40%) in IV group, in 4 patients (26.7%) in M group and in only 2 patients (13.3%) in BF group. Pruritus was encountered in 3 patients (20%) in IV group, in 4 patients (26.7%) in M group and in only 2 patients (13.3%) in BF group. Wound infection ivas reported in 9 patients; 3 in IV group and 6 in epidural group.
Conclusion : It could be concluded that continuous bupivacaine/fentanyl epidural analgesia is an appropriate
strategy for pain management during the postoperative period of obese/morbidly obese patients undergoing
major abdominal surgery with
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