Purpose: To determine the et~cacy and safety of patient-controlled epidural analgesia of morphine or fentanyl in combination with bupivacaine for postoperative pain relief. Methods: Forty ASA I-II patients scheduled for major abdominal surgery were studied. After insertion of a lumbar epidural catheter, patients were given a non-opioid general anaesthetic. After surgery patients complaining of pain, received a loading dose of 2 mg morphine (Group I) or 50/Jg fentanyl (Group II). For continuing pain, I mg morphine in 4 ml bupivacaine 0. 125% (0.25 mg.ml-' morphine and I tug'm1-' bupivacaine, Group I) or 20/ag fentanyl in 4 ml bupivacaine 0.125% (5/lg-ml -~ fentanyl and I mg.ml -r bupivacaine Group II) were administered. Blood pressure, heart rate, respiratory rate and Sp02 were monitored. Assessments of pain (VAS), nausea-vomiting, motor block, pruritus and sedation were recorded for 24 hr. Results: No difference in pain or sedation was observed between groups. The 24 hr postoperative opioid consumption was 15.50 -+ 7.53 mg morphine and 555.10 _+ 183.85 ~ug fentanyl. Total bupivacaine 0.125% consumption was 58.00 + 30.14 ml in Group I and 101.05 + 36.77 ml in Group II. One patient in Group II complained of motor weakness in one leg. The incidence of nausea (Group 1 45%, Group II 10% P < 0.05) and pruritus (Group I 30%, Group II 5% P < 0.05) was less in patients receiving fentanyl. Conclusion: Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine. Objectif : DEterminer I'efficacitE et la s&uritE d'emploi de I'analg&ie p&idurale, contr61& par le patient, ~ base de morphine ou de fentanyl en combinaison avec la bupivacaine pour le soulagement de douleurs postop&a-toires. M~thode : Quarante patients ASA I-II devant subir une chirurgie abdominale majeure ont &E &udi&. Apr& I'insertion d'un catheter pEridural Iombaire, les patients ont re~u un anesthEsique gEnEral sans opioide. Les patients qui ont ressenti des douleurs apr& I'intervention ont regu une dose d'attaque de 2 mg de morphine (Groupe I) ou de 50/~g de fentanyl (Groupe II). Pour soulager une douleur prolong&, I mg de morphine dans 4 ml de bupivacaine 0, 125 % (0,25 mg'ml l de morphine et I mg.mg" de bupivacaine, Groupe I) ou 20 ~g de fentanyl dans 4 ml de bupivacaine 0, 125 % (5/ag.ml-' de fentanyl et I mg'ml -~ de bupivaca,ne, Groupe II) ont EtE administr&. La tension art&ielle, la frEquence cardiaque, le rythme respiratoire et la Sp02 ont EtE enregistr&. Les Evaluations de la douleur (EVA), les naus&s et les vomissements, le blocage moteur, le prurit et la sedation ont EtE notes pendant 24 h. R~sultats : Aucune difference n'a EtE observ& entre les groupes concernant la douleur ou la sedation. La consommation d'opioide pendant 24 h aprEs I'opEration a EtE de 15,50 __-7,53 mg de morphine et 555, 10 _+ 183,85/ag de fentanyl. La consommation totale de bupivaca'ine 0,125 % a EtE de 58,00 ---30, 14 ml dans le Groupe Iet de 101,05 -+ 36,77 ml dans le Groupe II. Un patient du Groupe II s'est...
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