[Continuous epidural perfusion with meperidine on demand for the treatment of postoperative pain]

To determine whether epidural administration of meperidine through a system affording patient-controlled analgesia (PCA) is appropriate for postoperative pain.

A prospective double-blind study of 30 patients undergoing high abdominal surgery randomly into two groups. After surgery with the same type of general anesthesia for both groups, group A received epidural meperidine through a PCA pump (initial boluses of 50 mg + infusion of 10 mg/h with additional doses of 25 mg upon patient demand and closure time of 90 min). Control group B received 0.9% saline serum through an epidural PCA system with identical perfusion characteristics. All patients had access to additional analgesia with subcutaneous meperidine (1 mg/kg weight).

There was a wide interindividual variation in meperidine consumption in group A, with a mean total dose of 301.4 +/- 73 mg in 24 hours and no patient requiring additional subcutaneous meperidine. Subcutaneous meperidine required in group B reached 273 +/- 65.8 mg in 24 hours, with no significant differences between groups A and B for total dose given. No side effects inherent to the technique were found. Sufficient control of pain was achieved for all patients receiving epidural meperidine.

Epidurally administered PCA with meperidine affords better pain relief with greater patient satisfaction than the same amount of drug given subcutaneously in successive doses upon patient request.