[Effect of adrenaline on the quality of postoperative epidural analgesia]

The aim of the study was to assess the efficacy and safety of patent controlled analgesia (PCEA) combining opioid-local anesthetic mixture and adrenaline administered after thoracotomy and laparotomy. 164 adult patients after major thoracic and abdominal surgery were enrolled in prospective randomized study. All patients were given PCEA using 0.125% bupivacaine and fentanyl (2 mcg/ml) eithr without (BF group, n = 73) or with adrenaline (2 mcg/ml) (ABF group, n = 91). Pain scores were assessed in rest and coughing by 100-point visual analog scale (VAS) at 3, 6, 12 and 24 hours after ICU admission. In addition, the consumption of medication and the incidence of adverse effects (pruritis, urine retention, and nausea/vomiting) were recorded. Data were compared by the means of Student's t-test and chi2 test. p < 0.05 was regarded as statistically significant. VAS in coughing was significantly lower in the ABF group at 3rd 6th 12th, 18th and 24th hour after ICU admission. The consumption of medication requested for the adequate analgesia (VAS < 3) decreased in the ABF group compare to the BF group. The number of incidence of side effects was lower in the ABF group. The outcome of the study shows that use of PCEA with bupivacaine--fentanyl mixture with adrenaline after major surgery reduces the consumption of both bupivacaine and fentanyl and lowers the incidence of adverse effects, therefore improving the quality of analgesia.