Management of postoperative pain with propofol and epidural morphine after esophagectomy

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Optimum initial and continuous follow-up dosage of epidural morphine for pain relief and sedation of ventilated patients following esophagectomy has not been determined. This study examined the combined analgesic and sedative effects in 45 patients following esophagectomy. An epidural catheter was introduced into the Th 10-11 intervertebral space and further advanced 3 to 5cm cephalad. Propofol was administered post-operatively to the patients in the study. A loading dose was used to establish the desired level of sedation, and then the sedation level was maintained with constant rate infusion of propofol using a constant-rate peristaltic infusion pump. Patients were given respiratory management overnight, such as intermittent positive pressure ventilation during propofol infusion. One hour before surgery, a single dose of epidural morphine was injected and a syringe pump connected for continuous administration. Patients were divided into 3 groups [epidural morphine (mg)+continuous epidural infusion (mg/hr), total dose (mg)]: Groups A (2+0.38, 18), B (5+0.31, 15) and C (10+0.21, 10). Group A required a significantly higher dosage of propofol than Groups B and C, with no significant difference between Groups B and C. Our findings suggest that a 5-mg bolus dose of morphine coupled with continuous morphine (15mg) infusion is an optimal regimen for providing excellent management of postoperative pain combined with reliable sedation with limited adverse effects in ventilated patients following esophagectomy. Higher doses of epidural morphine may involve a risk of drug accumulation precipitating respiratory depression and hypotension. This clinical experiment was a prospective and randomized study.
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Management of postoperative pain with propofol and epidural morphine after esophagectomy

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