Two Different Epidural Analgesic Combinations: Morphine vs. Fentanyl/Bupivacaine or Fentanyl/Ropivacaine and Their Post Operative Effects
UNIFORMED SERVICES UNIV OF THE HEALTH SCIENCES BETHESDA MD BETHESDA United States
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Postoperative pain can effect almost every organ function and may adversely influence postoperative morbidity and mortality. This studys purpose was to compare one institutions postoperative epidural opioidlocal anesthetic protocol, currently fentanyl with bupivacaine or ropivacaine and compare it to the previously used morphine. Pain control efficacy and incidence of side effects were compared using a retrospective chart audit. The sample was obtained from the inpatient records of a 155-bed medical center. A description of patients age, gender, surgical procedure, opioidlocal anesthetic, side effects, treatments, and occurrence of break through pain were recorded using a tool adapted by Bell for a similar study and data were analyzed using the SPSS program. Data analysis revealed that differences between groups were statistically insignificant regarding age, gender, and surgery type. Occurrence of breakthrough pain and side effects were similar for fentanyllocal anesthetic and morphine. No significant respiratory depression was reported in either group. Nausea and vomiting incidence between groups was similar and seemed related to type of surgery, with a higher incidence in abdominal procedures. Pruritis and urinary retention was equal in both groups. Under-reporting and incomplete documentation, as well as the management of breakthrough pain were found to be problematic. Prospective research, ongoing education of staff and patients, and further development of the anesthesia directed pain management program at this facility is recommended.