Postoperative epidural infusion of morphine and bupivacaine is safe on surgical wards

摘要: Background: There was an obvious need to improve the quality and safety of our postoperative pain treatment introduce improved routine service on surgical wards. Methods: It decided use epidural infusion morphine 0.04 mg/ml bupivacaine 2.5 (0.25%): 4–8 ml/h as relief after major surgery. An education programme run emphasising benefits, side-effects importance regular monitoring intensity, vital functions (respiratory rate, blood pressure, heart rate), motor function legs for additional drugs in order detect well lack adequate analgesic effect. A detailed observation sheet used collecting information every 2 h throughout period secure adjustment treatment. Close contact maintained with wards. Results: We present a analysis first 2000 patients, mainly orthopaedic (46.1%), gastrointestinal (32.0%), urologic (8.7%) vascular (8.5%) Duration less than 24 41.4% more 48 29.7%. Pain most best surgery lower extremities (mean VAS 0.15/10.0 (95% confidence interval 0.09–0.23)) 0.49/10 (0.43–0.54)) thoracic 0.59/10 (0.38–0.81)). The stopped due respiratory depression 3 patients (0.15%). Four (0.2%) had systolic pressure <80 mmHg be treated vasopressors. total 56 (2.8%) were considered problem excessive sedation (0.4%), hypotension (0.7%), (1.6%) or extremity paralysis (0.05%). All urinary catheter until 6 termination One patient accidentally placed subarachnoidally experienced severe depression. No permanent sequelae recorded but traumatised developed abscesses weeks treatment, which resulted paralysis. Late response warning signs might have contributed irreversible paraplegia. Conclusion: Our experience this analgesia regime is favourable. has been easy administer monitor. excellent, few picked up by established routines followed ward staff except trauma who abscesses. wards motivated kind work. Education strict surveillance are mandatory prompt action when develops (e.g. limb paralysis).