A Comparative Study of Epidural Administration of Morphine and Fentanyl on Analgesic Effects and Complications / 대한마취과학회지

ABSTRACT

The discovery of the 1970s, that morphine acts on the spinal cord, opened a new field of neuropharmacological inquiry and exploration of the greatest analgesic power of intraspinal narcotics. However not only hydrophilic and poorly lipid-soluble drugs such as morphine may be expected to travel slowly to pass out of the CSF into the lipid tissues of the neuraxis but also many adverse side-effects such as respiratory depression, urinary retention, pruritus,nausea and vomiting may be expected to develop in the morphine treated patients. In contrast to morphine, highly lipid-soluble narcotics such as fentanyl pass relatively freely between the dura and pia-arachnoid, rapid onset of action and fewer adverse effects may be expected to develop in the fentanyl-treated patients. To assess the clinical usefulness of epidural administration of fentanyl rather than morphine, we compared the onset and duration of analgesic action, self-satisfactory of analgesia and adverse side-effects between morphine and fentanyl treated 27 surgical patients. The results were as follows 1) The onset time of analgesia in the epidurally fentanyl 50 ug treated group (F50 group) and 100 ug treated group (F100 group), 12+/-3 and 9+/-3 min respectively, were significantly shortened as compared with those in the morphine 5 mg treated group (morphine group), 21+/-2 min (p<0.05). 2) The duration of analgesic action in the F50 and F100 groups, 2.58+/-0.39 and 5.43+/-1.33 hours respectively, were significantly shortened as compared with morphine group, 14.30+/-2.16 (p<0.05). 3) Among 9 morphine treated patients, 8 patients feeled excellent or good analgesia. Also 9 of 10 fentanyl 50 ug treated and 7 of 8 fentanyl 100 ug treated patients feeled excellent or good analgesia. 4) Major complications in the morphine group were urinary retention 4 cases, nausea and vomiting 4 cases and pruritus 3 cases. Whereas only 1 patient in the F100 group complained of nausea and vomiting.