Postoperative epidural infusion of a mixture of bupivacaine 0.2% with fentanyl for upper abdominal surgery. A comparison of thoracic and lumbar routes.

Abstract

Thirty-three patients who had undergone elective open cholecystectomy were studied in a prospective, randomised comparison of thoracic (n = 17) and lumbar (n = 16) epidural routes of administration of a mixture of bupivacaine 0.2% with fentanyl 10 micrograms.ml-1 for postoperative pain. Pain relief, cardiovascular stability, respiratory rate and side effects were assessed by a 'blinded' observer at specific times in the 24 h study period. The thoracic epidural route proved significantly more reliable than the lumbar and provided effective analgesia in all patients (p < 0.05). This was not accompanied by significant hypotension or respiratory depression. The incidence of side effects attributable to use of the lumbar epidural route was significantly higher than with the thoracic route (p < 0.05). This study supports the use of the thoracic epidural route for postoperative pain management after upper abdominal surgery.