Abstract

CALDERON, E. et al. Analgesic transition after remifentanyl-based anaesthesia in major abdominal surgery: morphine-ketorolac versus epidural analgesia. Rev. Soc. Esp. Dolor [online]. 2004, vol.11, n.1, pp.9-14. ISSN 1134-8046.

Objectives: The aim of our study was to compare analgesic effectiveness and side effects of two analgesic regimes: epidural analgesia with bupivacaine-fentanyl versus intravenous analgesia with morphine-ketorolac in the transition from a remifentanyl-based anaesthesia after major abdominal surgery during the first 6 hours of postoperative. Material and methods: We conducted a clinical study in 30 adult patients scheduled for major abdominal surgery. A standard anaesthetic technique was used in all the patients. Forty minutes after the end of the surgical procedure, patients in group E received 15 ml of bupivacaine 0.25% and 1 mg.kg^-1 of fentanyl epidurally, while patients in group M received 0.15 mg.kg^-1 of morphine chloride and 30 mg of ketorolac intravenously. During the first 6 hours after extubation, we assessed hemodynamic and respiratory parameters, degree of sedation and post-anaesthetic recovery, and time elapsed until patient discharge from the post-anaesthetic recovery unit, postoperative pain severity assessed through an elementary verbal scale and a visual analogical scale, side effects and need of rescue analgesia. Morphine 0.05 mg.kg-1 was used in group M and epidural bolus of 5 ml of bupivacaine 0.25% in group E as rescue analgesic when between assessments pain severity was ≥ 2 according to the EVS. Results: We have not found any statistically significant differences between both study groups in terms of general features, hemodynamical and respiratory parameters, degree of sedation, degree of recovery and election for discharge. Rescue needs were significantly greater in group M (40%) compared to group E (13%) (p <0.05). The incidence of nausea was significantly greater in group M (46.5%) compared to group E (6.5%) (p <0.05). Conclusion: Both epidural analgesia with bupivacaine-fentanyl and intravenous analgesia with morphine-ketorolac were effective for the management of severe postoperative pain. However, analgesic transition after remifentanyl-based analgesia in major abdominal surgery using epidural analgesia provided appropriate analgesia, with three times less rescue analgesia needs and incidence of nausea and vomiting compared to intravenous analgesia with morphine-ketorolac.

Keywords : Remifentanyl; Postoperative analgesia; Epidural analgesia; Morphine; Ketorolac.

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