From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies.

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Relief of pain with epidural morphine was evaluated in five patient subjects during two consecutive twenty-four hour periods after cholecystectomy. In one period, each subject received lumbar epidural morphine, first 4-6 rag, and twelve hours later, 2-3 rag; in the other period, epidural placebo at the same times. Except for four hours before each injection and twenty minutes thereafter, intramuscular morphine was administered as required throughout. The experiments were double-blind. Epidural morphine, unlike epidural placebo, reduced both a visual pain analogue score (p < 0.05) and a pain questionnaire score (p < 0.01) twenty minutes after injection. Epidural morphine compared to placebo reduced by one-half the total amount of narcotic (epidural plus intramuscular) administered over the twenty-four hour period (p < 0.05). Four of five subjects clearly preferred analgesia with epidural morphine over the effect of placebo plus therapeutic doses of intramuscular morphine. We conclude that epidural morphine, administered in this manner, is effective in relieving pain after cholecystectomy and that it may be preferred by patients over conventional intramuscular morphine.KEY WORDS: EPIDURAL MORPHINE; POSTOPERATIVE ANALGESIA CLINICAL TRIALS suggest that small doses of opiates in the epidural space produce good to excellent pain relief after thoracic, abdominal and orthopaedic surgery, t-s The analgesia is said to be "selective" in that other sensory, motor and sympathetic modalities are not obviously impaired. The duration of effect appears to be prolonged (6-24 hours) and the requirement for only a small dose of narcotic (e.g. morphine 2-5 rag) is believed to reduce the risk of adverse systemic effects. Thus, epidural opiate for postoperative pain relief might have a more favourable therapeutic to side effect ratio than either systemic narcotic or regional local anaesthetic blocks. 6In spite of the initial enthusiasm for epidural narcotic in the treatment of postoperative and other types of pain, there have been to our knowledge only two studies comparing epidural , vol. 28, no. 6, November 1981 narcotic to placebo in a double-blind fashion. 7'8 Both were conducted in patients after abdominal surgery; one found epidural morphine to be effective, 7 but the other failed to detect a difference from placebo) Unfortunately the former study employed only an indirect estimate of pain relief (observer estimate of quality of deep breathing) and neither study "crossed subjects over" from treatment to placebo. To determine the efficacy of an analgesic in the clinical setting, one must pay scrupulous attention to the possibility of interference from added variables, employ sensitive methods for estimating pain relief, and guard carefully against the potential for subject and/or observer bias. 9"~ With these objectives in mind, we have attempted to determine if one method of administering epidural morphine relieves pain following cholecystectomy. Our study employed a double-blind cross-over technique and several meth...