Résumé
This study was undertaken to evaluate the analgesic effect of the combination of epidural morphine and bupivaeaine versus epidural morphine alone for postoperative pain. In a ran- domized study, epidural infusions of morphine combined with bupivacaine were compared with bolus epidural injection of morphine alone for postoperative analgesia at rest and dur- ing mobilization and coughing in 80 patients after elective cesarean section. Eighty patients were divided into 2 groups ; M (control) group ; bolus administration of morphine (4mg) and bolus reinjection (4mg) after 24 hours, MB (experimental) group ; bolus administration of morphine (1.5mg) and continuous administration of bupivscaine and morphine (7mg morphine in normal saline 7ml plus 100ml of 0.2% bupivacaine) with the Baxter infusor. Static and dynamic pain scores at 6, 12, 24, 36, 48 hours after operation were examined and side effects were recorded. The results were as follows ; 1) Static VAS was significantly lower in group MB compared with group M at 12, 24, and 36 hours (p< 0.05). 2) Dynamic VAS was significantly lower in group MB compared with group M throughout the study (p<0.01). 3) Pruritus was greater in group MB than in group M but statiscally not significant. 4) Nausea was greater in group M than in group MB but stetiscally not significant. 5) None of patients had respiratory depression. We concluded that continuous epidural infusion of bupivacaine and morphine is more useful than morphine alone for post operative pain management after cesarean section.