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Comparison of the Efficacy of Epidural Morphine Given by Intermittent Injection or Continuous Infusion for the Management of Postoperative Pain
  1. Richard L. Rauck, M.D.*,
  2. P. Prithvi Raj, M.D.,
  3. Donna C. Knarr, B.S.N.,
  4. Donald D. Denson, Ph.D.§ and
  5. Kevin L. Speight, M.D., M.B.A.*
  1. *From the Department of Anesthesia, The Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina;
  2. National Pain Institute, Atlanta, Georgia;
  3. Anesthesia Department, University of Cincinnati, Cincinnati, Ohio; and
  4. §Department of Anesthesia, Emory University, Atlanta, Georgia
  1. Reprint requests: Dr. Rauck, Pain Control Center, Wake Forest University Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157-1077.


Background and Objectives To compare the effectiveness and side effects of epidural morphine sulfate (MSO4), delivered by continual infusion or intermittent bolus.

Methods Thirty patients undergoing upper abdominal surgery were randomized into two equal groups to receive MSO4 through a thoracic epidural catheter by one of two methods. Group 1 patients received an initial bolus of morphine (0.07 mg/kg) at the end of surgery, followed by injections of 2-5 mg morphine into the epidural catheter on demand. Patients in group 2 received an initial bolus of morphine (0.03 mg/kg) during surgical peritoneal closure and were immediately started on an infusion of 0.01% morphine at 5 mL/hour (0.5 mg/hour). The infusion dose was titrated from 0.2 to 1.0 mg/hour, dependent on side effects. Outcome measurements included pulmonary function studies, arterial blood gases, morphine plasma levels, pain relief scores, global evaluations, and side effects.

Results No difference existed between groups in forced vital capacity, forced expiratory volume in 1 second, or in arterial blood gas measurements. Side effects were similar in both groups. Respiratory depression was not seen in either group. Group 2 reported significantly better analgesia than group 1 on postoperative days 1 and 2 (P < .01). Peak plasma morphine levels for group 1 were significantly higher than the steady state plasma morphine levels for group 2 (P < .05).

Conclusions Continuous epidural infusion provides better analgesia without increased side effects for postoperative pain when compared with an intermittent (or demand) bolus technique.

  • analgesia
  • epidural
  • analgesics
  • injections
  • morphine
  • pain
  • postoperative

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