Abstract

The requirements for providing postoperative analgesia with epidural local anesthetic solutions are outlined. The epidural catheter position should correspond to the dermatome of the wound site. Bupivacaine is suggested as the best available local anesthetic solution for continuous analgesia. One of four regimens were used for each patient undergoing lower abdominal surgery in a gynecological unit. Continuous infusions of either 0.1% plain bupivacaine 20 ml/hr or 0.2% plain bupivacaine 10 ml/hr were given by an intravenous infusion pump into an indwelling epidural catheter. Analgesia was adequate in most patients, although more had poor analgesia overnight with the higher concentration of bupivacaine. Intermittent top-ups were given either by a specially designed pump, delivering 6-10 ml every 2 hours of 0.5% bupivacaine, or by nursing staff, 4-5 ml every 1-2 hours. The patients receiving top-ups by automatic pump had good analgesia which proved to be the most satisfactory and was maintained for 24 hours. Reasons for failure to provide adequate analgesia, side effects, and their management are discussed.