Comparison of Continuous Epidural Analgesia with Fentanyl-Bupivacaine Versus Intravenous Patient-Controlled Analgesia with Morphine for Postoperative Pain Control / 대한마취과학회지

ABSTRACT

BACKGROUND: The postoperative pain control has improved with use of continuous epidural analgesia(CEA) and intravenous patient-controlled analgesia (IV-PCA). We compared the efficacy and safety of CEA using fentanyl-bupivacaine with IV-PCA using morphine in the postoperative pain control after total hysterectomy. METHODS: Sixty women undergoing hysterectomy were assigned to receive an epidural bolus of morphine 1 mg and 0.125% bupivacaine 10 ml, followed by a CEA with 0.00036% fentanyl and 0.075% bupivacaine at a rate of 5 ml/hr(CEA group) or intravenous bolus of morphine 2 mg followed by a IV-PCA with 0.1% morphine(IV-PCA group). Visual analog scales(VAS) for pain were recorded at 1, 6, 12, 24 and 48hr postoperatively and side effects and degree of satisfaction were noted. RESULTS: Resting and dynamic pain scores were significantly lower in the CEA group than in the IV-PCA group throughout the study period. The average pain scores using VAS in two groups were less than 4. There were no significant differences in side effects and degree of satisfaction between two groups. CONCLUSIONS: The continuous epidural infusion of fentanyl and bupivacaine provided better postoperative analgesia than IV-PCA morphine. The average pain scores of IV-PCA group was less than 4 and the incidence of side effects and degree of satisfaction were not significantly different between two groups. So, we think IV-PCA morphine is a convenient and effective alternative to CEA fentanyl -bupivacaine in patients declining to receive CEA.