Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial
Background/Aim. Combined spinal-epidural-general anesthesia has several advantages over general anesthesia alone. This study was designed to compare the efficacy of intrathecal (IT) morphine alone, or in combination with bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE) analg...
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Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade
2013-01-01
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| Series: | Vojnosanitetski Pregled |
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| Online Access: | http://www.doiserbia.nb.rs/img/doi/0042-8450/2013/0042-84501300011S.pdf |
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| author | Slavković Zoran Stamenković Dušica M. Gerić Veselin Veljović Milić Ivanović Nebojša Tomić Aleksandar Ranđelović Tomislav Rašković Jelena Karanikolas Menelaos |
| author_facet | Slavković Zoran Stamenković Dušica M. Gerić Veselin Veljović Milić Ivanović Nebojša Tomić Aleksandar Ranđelović Tomislav Rašković Jelena Karanikolas Menelaos |
| author_sort | Slavković Zoran |
| collection | DOAJ |
| description | Background/Aim. Combined spinal-epidural-general anesthesia has several advantages over general anesthesia alone. This study was designed to compare the efficacy of intrathecal (IT) morphine alone, or in combination with bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE) analgesia, in patients undergoing elective total gastrectomy. Methods. This prospective, randomized double-blind study included 60 patients undergoing total gastrectomy under general anesthesia and CSE. We compared the analgesic effect of lumbar IT morphine 300 μg (the group M, n = 20) vs morphine 300 μg + bupivacaine 2 mg (the group MB, n = 20) vs morphine 300 μg + bupivacaine 2 mg + fentanyl 25 μg (the group MBF, n = 20) given after thoracic epidural catheter placement (T6-7) but before general anesthesia induction. Pain visual analogue scale (VAS) at rest (R), with movement (M) and with cough (C), and the number of analgesia requests were assessed for 72 h and after epidural catheter removal. Results. Compared to other groups, the MBF group required significantly fewer additional intra-operative epidural bupivacaine doses (p < 0.001), whereas the M group required significantly more supplemental intraoperative intravenous fentanyl, compared with the MBF (p = 0.022) and MB groups (p = 0.005). Postoperative pain relief was satisfactory in all the groups at all the time. VAS-R and VAS-M did not differ significantly among the groups. Compared to the M group, VAS-C scores 30 min postoperatively were significantly lower in the MBF (p = 0.029) and MB groups (p = 0.002). Duration of analgesia was longer in the MBF and MB groups, but the difference reached no significance. The number of supplemental analgesia requests was similar in all the groups in the first 12 h and during 72 h. Additional analgesia requests after epidural catheter removal were similar in all the groups, and side effects were infrequent. Conclusion. Compared to IT morphine alone, triple IT combination administered as part of CSE provided better intraoperative analgesia, but conferred no benefit with regards to postoperative analgesia. |
| format | Article |
| id | doaj-art-93072312f8fc4e74895f9803b1fc7a10 |
| institution | DOAJ |
| issn | 0042-8450 |
| language | English |
| publishDate | 2013-01-01 |
| publisher | Ministry of Defence of the Republic of Serbia, University of Defence, Belgrade |
| record_format | Article |
| series | Vojnosanitetski Pregled |
| spelling | doaj-art-93072312f8fc4e74895f9803b1fc7a102025-08-20T03:20:36ZengMinistry of Defence of the Republic of Serbia, University of Defence, BelgradeVojnosanitetski Pregled0042-84502013-01-0170654154710.2298/VSP111011011SComparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trialSlavković ZoranStamenković Dušica M.Gerić VeselinVeljović MilićIvanović NebojšaTomić AleksandarRanđelović TomislavRašković JelenaKaranikolas MenelaosBackground/Aim. Combined spinal-epidural-general anesthesia has several advantages over general anesthesia alone. This study was designed to compare the efficacy of intrathecal (IT) morphine alone, or in combination with bupivacaine and fentanyl, as part of a combined spinal-epidural (CSE) analgesia, in patients undergoing elective total gastrectomy. Methods. This prospective, randomized double-blind study included 60 patients undergoing total gastrectomy under general anesthesia and CSE. We compared the analgesic effect of lumbar IT morphine 300 μg (the group M, n = 20) vs morphine 300 μg + bupivacaine 2 mg (the group MB, n = 20) vs morphine 300 μg + bupivacaine 2 mg + fentanyl 25 μg (the group MBF, n = 20) given after thoracic epidural catheter placement (T6-7) but before general anesthesia induction. Pain visual analogue scale (VAS) at rest (R), with movement (M) and with cough (C), and the number of analgesia requests were assessed for 72 h and after epidural catheter removal. Results. Compared to other groups, the MBF group required significantly fewer additional intra-operative epidural bupivacaine doses (p < 0.001), whereas the M group required significantly more supplemental intraoperative intravenous fentanyl, compared with the MBF (p = 0.022) and MB groups (p = 0.005). Postoperative pain relief was satisfactory in all the groups at all the time. VAS-R and VAS-M did not differ significantly among the groups. Compared to the M group, VAS-C scores 30 min postoperatively were significantly lower in the MBF (p = 0.029) and MB groups (p = 0.002). Duration of analgesia was longer in the MBF and MB groups, but the difference reached no significance. The number of supplemental analgesia requests was similar in all the groups in the first 12 h and during 72 h. Additional analgesia requests after epidural catheter removal were similar in all the groups, and side effects were infrequent. Conclusion. Compared to IT morphine alone, triple IT combination administered as part of CSE provided better intraoperative analgesia, but conferred no benefit with regards to postoperative analgesia.http://www.doiserbia.nb.rs/img/doi/0042-8450/2013/0042-84501300011S.pdfanesthesia, epiduralanesthesia, spinalmethodsfentanylbupivacainemorphineanalgesiagastrectomy |
| spellingShingle | Slavković Zoran Stamenković Dušica M. Gerić Veselin Veljović Milić Ivanović Nebojša Tomić Aleksandar Ranđelović Tomislav Rašković Jelena Karanikolas Menelaos Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial Vojnosanitetski Pregled anesthesia, epidural anesthesia, spinal methods fentanyl bupivacaine morphine analgesia gastrectomy |
| title | Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial |
| title_full | Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial |
| title_fullStr | Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial |
| title_full_unstemmed | Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial |
| title_short | Comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy: A prospective randomised, double blind clinical trial |
| title_sort | comparison of analgesic effect of intrathecal morphine alone or in combination with bupivacaine and fentanyl in patients undergoing total gastrectomy a prospective randomised double blind clinical trial |
| topic | anesthesia, epidural anesthesia, spinal methods fentanyl bupivacaine morphine analgesia gastrectomy |
| url | http://www.doiserbia.nb.rs/img/doi/0042-8450/2013/0042-84501300011S.pdf |
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