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Background and Aims Use of epidural opioids is a standard practice nowadays, not only for pain management during surgery but also in the postoperative period. It is well known that hydrophobic drugs distribute better to hydrophobic tissues such as fat located nearby epidural space instead of spreading to the cerebrospinal fluid, as is the case with fentanyl. Regarding morphine, it has been demonstrated that it is better used for spinal administration, whereas other opioids are more likely to be administered at the epidural space.

Methods In this case report, we present an 81-year-old male patient who underwent a pancreatectomy, splenectomy and partial gastrectomy by laparotomy. Prior to surgery, thoracic epidural technique was performed, the catheter placement was checked by epidural test dose and a single bolus of morphine 2 mg, dexamethasone 4 mg and ropivacaine 0.2% 3 ml was administered.

Results During the procedure, we used NOL (Nociception Level Index, Medasense) to monitor the effectiveness in which it was observed that no extra analgesia was needed during the surgery with <25 NOL value in 96% of the surgical time. In the postoperative period, patient controlled analgesia was used to determine if any extra analgesia was required after the initial bolus. No pain was referred by visual analog scale until 30 hours after surgery. No postoperative complications related with the use of opioids were found.

Conclusions This case report argues for the need of more studies about epidural analgesia by single bolus with morphine, dexamethasone and local anesthetics and clinical relevance for patients undergoing laparotomy.