EPIDURAL FENTANYL VERSUS FENTANYL-BUPIVACAINE INFUSIONS FOR POSTOPERATIVE PAIN RELIEF AFTER TOTAL ABDOMINAL HYSTERECTOMY

Postoperative epidural local anesthetic infusion, although provides potent analgesia after lower abdominal surgeries; yet it causes significant motor block especially with the commonly used bupivacaine concentrations (0.125% or higher). Patients and methods: We compared the analgesic effect of fentanyl-only epidural infusion in two different concentrations with the commonly used bupivacaine/fentanyl mixture for postoperative pain after total abdominal hysterectomy operations in 90 female patients who were divided into 3 groups. Group I patients received an epidural infusion of a mixture of 200 mcg fentanyl in 50 ml 0.125% bupivacaine. Group II patients received an epidural infusion of 200 mcg fentanyl in 50 ml 0.9% NaCl solution. Group III patients received an epidural infusion of 400 mcg fentanyl in 50 ml 0.9% NaCl solution. Results: It was found that in the first postoperative 8 hours the visual analog scale (VAS) in group II patients was significantly higher than the other two study groups that showed non-significant differences. At 12 and 16 hours postoperatively, the VAS was non-significantly different between the three study groups. Lastly, at 20 and 24 hours group III patients showed significantly lower VAS values than the other two study groups. Conclusion: 400 mcg fentanyl in 50 ml NS gave the same analgesic effect of bupivacaine 0.125%/fentanyl 200 mcg in 50 ml NS without any motor block, delayed ambulation, or hypotension when infused into the epidural space at the same rate of 10 ml/h for postoperative pain relief after total abdominal hysterectomy.