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British Journal of Anaesthesia, 2001, Vol. 87, No. 5 727-732
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Effect of epidural bupivacaine vs combined epidural bupivacaine and morphine on gastrointestinal function and pain after major gynaecological surgery

H. Jørgensen1, J. S. Fomsgaard1, J. Dirks1, J. Wetterslev1, B. Andreasson2 and J. B. Dahl1

1Department of Anaesthesiology and Intensive Care and 2Department of Obstetrics and Gynaecology, Herlev University Hospital, Copenhagen County, Denmark*Corresponding author

In a double-blind study, we investigated the effects of postoperative epidural local anaesthetic, with or without addition of epidural morphine, on postoperative pain and gastrointestinal function in patients scheduled for radical hysterectomy and pelvic lymphadenectomy. Forty patients were randomized into two study groups: 48-h postoperative epidural 0.2% bupivacaine 8 ml h–1 (bupi group) or 48-h postoperative epidural 0.2% bupivacaine/morphine 50 µg at 4 ml h–1 (bupi/morph group). Patients were observed for at least 96 h after surgery. No differences in pain at rest, during cough or mobilization were observed. Patients in the bupi group requested a significant greater amount of supplementary analgesics, but times to first flatus and defaecation were reduced compared with patients in the bupi/morph group. Itching was a significant problem in patients in the bupi/morph group. No differences in postoperative nausea and vomiting, mobilization or time to discharge from hospital were observed between groups. The addition of morphine to postoperative epidural bupivacaine has only limited effect on pain relief and increases time to normalization of gastrointestinal function.

Br J Anaesth 2001; 87: 727–32


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