Epidural opioids for postoperative pain relief following hepatectomy

Postoperative pain relief with epidural morphine or buprenorphine and intramuscular morphine was investigated in 67 patients undergoing hepatectomy. When the patient first complained of pain after surgery, 1 or 2mg of epidural morphine, or 0.06 mg of epidural buprenorphine given either at T 10-11 or L 3-4, or 0.1 mg/kg of morphine intramuscularly was administered. Lumbar epidural morphine 2mg, as well as thoracic epidural morphine 2mg, produced excellent and long-lasting pain relief. Nine of 12 patients receiving thoracic epidural buprenorphine 0.06 mg were completely pain-free. Thoracic epidural morphine 1 mg and lumbar epidural buprenorphine 0.06 mg produced incomplete analgesia. Analgesic duration of intramuscular morphine tended to be shorter than that of 2 mg of epidural morphine. PaCO2 increased significantly following thoracic epidural morphine 2 mg, although PaCO2 did not change after lumbar epidural morphine 2 mg. No patient had serious side effects. The lumbar epidural administration of 2 mg morphine may be recommended for postoperative analgesia following hepatectomy.