Comparative Effects of Continuous Epidural Morphine with Bupivacaine Mixture Infusion and Intramuscular Meperidine on Pulmonary Function after Upper Abdominal Surgery / 대한마취과학회지

ABSTRACT

BACKGROUND: Pain after upper abdominal surgery may cause shallow and rapid breathing, resulting in postoperative pulmonary complications. Intramuscular injection of narcotics may increase mortality and morbidity of pulmonary complications. Continuous epidural infusion of opioid with local anesthetic mixture may produce good analgesic action without hypoventilation and hypoxia. METHODS: Forty patients for upper abdominal surgery, chosen at random, were studied for postoperative pain relief. In grouop 1 (n=20), pain was managed by intramuscular injection with meperidine and in group 2 (n=20), it was managed by continuous thoracic epidural block with morphine and bupivacaine mixture. In both groups, pulmonary functions were assessed before operation, on the 1st postoperative day. the 2nd day and the 3rd day. RESULTS: In group 1 and 2, On the 1st postoperative day, FEV was 32.1% and 45.4% of the preoperative value, FVC was 31.9% and 42.4% and MEF was 34.4% and 46.7%, respectively(P<0.05). On the 2nd postoperative day, FEV was 38.6% and 54.8%(P<0.01), PEF was 31.7% and 42.5%, FVC was 37.1% and 49.8% and MEF was 43.2% and 59.6%(P<0.05). on the 3rd postoperative day, FEV was 46.3% and 68.7%, PEF was 38.7% and 54.4%, FVC was 43.8% and 63.1%(P<0.01) MEF was 56.1% and 69.7% of the preoperative value(P<0.05). CONCLUSIONS: As a result of pulmonary function test, we suggest that continuous epidural infusion of morphine with bupivacaine mixture will be an appropriate way of postoperative pain relief methods, with its potential effectiveness in aged, smoking, obese and debilitated patients with ventilatory dysfunction.