Abstract:
The challenge of peri-operative care is to create an optimal balance between treatment and untoward effects of medications used to insure patient safety, comfort and rapid recovery. In this study we tried to compare analgesia, bowel motility and early oral intake in three different undergoing major abdominal surgeries. One hindered and twenty patients ASA class Ι-ΙΙΙ undergoing major abdominal surgery were randomized in one of four groups (n=30 for each), three thoracic epidural groups received 4-6 ml/hour of: bubovacaine025% (group B),Bupivacaine 0.125%+0.05 mg morphine/ml (group M),or bupivacaine 0.125%+ fentanyl 4μg/ml(group F). The forth group a control group (group C), received 10 mg intramuscular morphine every 8 hours for 48 hours postoperatively. Analgesia, bowel motility, early oral intake and side effects were recorded over a study period of 48 hours. Analgesia was supplemented with non-steroidal anti inflammatory drugs, and I.V. Morphine on demand.
Analgesia score were comparable in groups M and F and significantly lower in group B and C. return of intestinal sounds and passage of flatus were significantly earlier in group F, and Comparable in group M and B with significant difference compared to group C. the need for additional analgesics frequency and doses were significantly lower in epidural groups. Total consumption of analgesic drugs was lower in epidural group and significantly lower in group F in the first post operative day. Incidence of side effects was lower in group F. compared to the other groups. Patients mobility was earlier in group M and F. total number of patients tolerated early intake was significantly higher in epidural group compared to group C.
Conclusions: analgesia, bowel motility, and early oral intake were better with thoracic epidural analgesia than traditional analgesics after major abdominal surgery.