Abstract
17 upper abdominal surgery patients who received general anesthesia and muscle relaxants followed by intravenous morphine for postoperative pain relief. Metha- done, 1.0 mg, hydromorphone, 1.0 mg, or morphine sulfate, 5 mg, was administered epidurally and increments were repeated as necessary until satisfactory analgesia was reported, with the following results (mean ± SD): intravenous morphine: latency 3 to 10 minutes, duration 3.1 ± 1.6 hours; epidural methadone: latency 17.2 ± 4 minutes, duration 5.6 ± 2.7 hours; epidural hydromorphone: latency 22.5 ± 6 minutes, duration 9.8 ± 5.5 hours; epidural morphine: latency 36 ± 6 minutes, duration 16.4 ± 7 hours. Duration of action was slightly longer after lower abdominal surgery. Addition of epinephrine 1 /200.000 to the epidural narcotic solutions did not prolong duration. Narcotic requirements for satisfactory analgesia were approximately the same by the intravenous route as by the epidural route and equivalent to 8.5 to 9 mg of morphine. FEV, was reduced to 36.8 ± 13.2% of preoperative control values after general anesthesia and muscle relaxants and to 46 ± 12% of control after epidural and general anesthesia. Intravenous morphine improved FEV, to 45.3 ± 12% of control, whereas epidural narcotics and local anesthetics produced a greater increase of FEV, in the following amounts: epidural local anesthetic to 68.7 ± 9.1% of control and epidural narcotics to 67.1 ± 14.7% of control. Epidural narcotics did not cause sympathetic depression or bladder dysfunction, and analgesia was segmental. We conclude that epidural narcotics in adequate dosage are an effective means for production of prolonged and segmental postoperative analgesia. Presented in part at the Annual Meeting of the American Society of Regional Anesthesia, March 13–16, 1979, San Francisco, California. Reprint requests to Dr. Bromage. Accepted for publication April 8, 1980. © 1980 International Anesthesia Research Society...