The Effect of Morphine on Pain and Bowel Function after Colonic Surgery:Epidural Bupivacaine-morphine Versus Intravenous Patient-controlled Analgesia with Morphine / 대한마취과학회지

BACKGROUND:Gastrointestinal paralysis after abdominal surgery has long troubled both patients and surgeons. Gastrointestinal side effects still constitute a major drawback in the acute use of opioids. Choice of postoperative analgesia may affect the rate of recovery of gastrointestinal function. The purpose of the present study was to investigate the influence of intravenous and epidural morphine on recovery of bowel function and pain by measuring intestinal motility and the visual analogue scale after colon surgery. METHODS: Twenty patients undergoing colon surgery used postoperative pain contol. Patients were allocated to receive either IV PCA (patient-controlled analgesia) with morphine or CEA (continuous epidural analgesia) with 0.1% bupivacaine-0.04% morphine. Patients were assessed for pain with a visual analogue scale, and for side effects at 1, 6, 12, 24, 48 hours postoperatively. Arterial blood samples for the measurement of blood gas and plasma concentration of morphine were taken. The time to first postoperative passage of flatus and feces, length of nasogastric therapy, time to liquid, soft and solid food intake, daily and total morphine requirement and length of hospital stay were recorded. RESULTS: There were no significant differences in bowel movement outcome except in length of nasogastric therapy, but the CEA group had significantly lower pain scores and required fewer days of nasogastric therapy when compared with the IV PCA group. CONCLUSIONS: These observations indicate that IV PCA with morphine and CEA can be used to relieve postoperative pain without prolonging the recovery of bowel movements, but CEA with bupivacaine and morphine constitutes an effective means of analgesia.

Causes and treatment of gastrointestinal complications following anterior approach to thoracolumbar fracture and dislocation / 中华创伤杂志

Objective To explore the causes and treatment of gastrointestinal complications after anterior approach for thoracolumbar fracture and dislocation.Methods A retrospective analysis was carried out in 153 cases with thoracolumbar fracture and dislocation undergone anterior approach from Jan- uary 1999 to October 2003.Postoperative gastrointestinal complication was seen in 15 cases including sev- en with dynamic intestinal obstructions,three with stress ulcer,three with intestinal bacteria imbalance, one with tuberculosis peritonitis resulted from dissemination of primary tuberculosis,and one with acute relapse of chronic appendicitis.Results All patients were effectively cured by using corresponding methods in regard of different causes.Conclusions(1)Gastrointestinal complications following ante- rior approach for thoracolumbar fracture and dislocation are mainly resulted from following causes,ie,se- rious primary trauma,primary gastrointestinal vegetative nerve injury or that caused by surgical operation, intraoperative contusions of abdominal viscera,postoperative retroperitoneal hematoma,acute lesion of gastric mucous membrane as well as imbalance of intestinal flora.(2)Correct treatment of primary trau- ma,meticulous operation,reasonable utility of antibiotics and appropriate management can effectively prevent and control gastrointestinal complications.