Enhanced pain management for postgastrectomy patients with combined epidural morphine and fentanyl

To determine whether clinical advantages could be demonstrated by epidural fentanyl given in addition to epidural morphine for postgastrectomy analgesia.

One-hundred and twenty two patients undergoing elective gastrectomy were prospectively studied in a randomised, double-blind fashion. All patients received epidural lidocaine 1.5% with epinephrine (1:200,000) followed by light general anaesthesia for surgical anaesthesia. They were assigned to four groups according to the combinations of each epidural opioid: 2 mg morphine alone, 2 mg morphine + 100 micrograms fentanyl, 4 mg morphine alone, and 4 mg morphine + 100 micrograms fentanyl. Morphine and fentanyl were given epidurally approximately 60 and 15 min, respectively, before the completion of surgery.

Addition of epidural fentanyl to both doses of morphine not only decreased intensity of pain associated with coughing during the early postoperative period, but also prolonged the time until the first analgesic request at each morphine dose studied. Of the combination doses, 4 mg morphine + 100 micrograms fentanyl provided the longest time to the first request for analgesic, and was associated with least amount of postoperative analgesic supplement and best patient satisfaction without increasing incidence of side effects.

The addition of 100 micrograms fentanyl to 2 mg or 4 mg epidural morphine provides clinical advantages over morphine alone for post-gastrectomy analgesia.