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October 22, 2008
9:00 AM - 11:00 AM
Room Hall E2-Area E,
Rehabilitation after Major Abdominal Surgery: Comparison of Epidural and Intrathecal Analgesia
Adel Ammous, M.D., Ph.D., Tarak Wannes, M.D., Hatem Ammar, M.D., Mohamed Anis Rejeb, M.D., Ali Cherif, M.D., Ph.D.
Anesthesia and Intensive Care, Rabta University Hospital, Tunis, Tunis, Tunisia
Advantages of epidural compared to parenteral analgesia on rehabilitation are well known. Intrathecal analgesia remain an effective and simple technique. We compared, in a prospective manner, effects of either intrathecal morphine or continuous epidural analgesia on postoperative outcome after major adbominal surgery.

Methods : 84 patients undergoing major abdominal surgery were randomly assigned to one of two groups : Group R received intrathecal morphine (0,3 mg) 30 min before surgery. Group P received at the end of the surgical incision a continuous infusion of bupivacaine 0,125% and fentanyl 2 µ via an epidural thoracic catheter previously inserted between T8-T10. Visual analogue scale (VAS) at rest and while coughing, mean arterial pressure (PAM), pulse oximetry (SpO2), PaO2, PaCO2 and respiratory rate (RR) were recorded by a blind observer at different times from the end of surgery to t48= 48h after surgery. Time to ileus resolution, time to deambulation, time to discharge, side effects (pruritus, nausea and vomiting, sedation), and patient satisfaction were also evaluated.

Results : The two groups were comparable in terms of demographic data and type of surgery. Pain scores were significantly lower in group P than in group M at rest (P<10-3) and during coughing (P< 10-3). Hypotension was more frequent in group P (P=0,03). No differences in RR, degree of sedation, pulse oximetry and other side effects were observed between the two groups. Time to ileus resolution (26,33±8,3 vs 40,8±8h ; P<10-3), time to deambulation (31±13,1 vs 47,7±13,8h ; P<10-3) were shorter in Group P compared to group R. The time to discharge was shorter in P group but not statistically significant (13,48±2 vs 12,76±1,9 days ; P=0,92).

Conclusion : Continuous epidural analgesia with bupivacaine and fentanyl is more effective than intrathecal morphine on rehabilitation after major abdominal surgery in term of time to ileus resolution, time to deambulation and quality of analgesia but it is associated with a higher incidence of hypotension.

Anesthesiology 2008; 109 A1702