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DOI: 10.4172/jpmme.1000115
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Pain Management & Medicine
Research Article OMICS International

Continuous Perioperative Thoracic Epidural Fentanyl-Bupivacaine

Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in
Patients Undergoing Major Upper Abdominal Cancer Surgeries
Elzohry AAM1*, Abd-El-moniem Bakr M2, Mostafa GM2, Mohamad MF2 and Ahmed EH3
1
Department of Anesthesia, ICU and Pain Relief, South Egypt Cancer Institute, Assiut University, Egypt
2
Department of Anesthesia and ICU, faculty of medicine, Assiut University, Egypt
3
Department of Clinical pathology, South Egypt cancer institute, Assiut University, Egypt

Abstract
Background: Major upper gastrointestinal cancer surgeries induce postoperative pain, that if not controlled may
cause various organ dysfunctions and prolonged hospital and ICU stay. Thus an appropriate pain therapy to those
patients must be applicated.
Objective: To compares the effects of continuous perioperative thoracic epidural Fentanyl-bupivacaine infusion
versus continuous perioperative Fentanyl intravenous infusion in patients undergoing major upper gastrointestinal
cancer surgery.
Methods: 60 patients (ASA II) of either sex were scheduled for elective upper gastrointestinal cancer surgeries.
Patients were allocated randomly into two groups (30 patients each) to receive: continuous peri-operative epidural
infusion with bupivacaine 0.132 and fentanyl (TEA group), or continuous peri-operative intravenous infusion with
fentanyl (control group). Postoperative pain was assessed over 72 h using visual analogue scale (VAS). The intra
and post-operative haemodynamic, sedation score and overall patient fentanyl consumption were recorded. Any
concomitant events like nausea; vomiting, pruritus or respiratory complications were recorded postoperatively.
Results: There was a significant decrease in pain sensation in TEA group during first day postoperative. Patient
haemodynamics was significantly decreased in TEA group. As regard sedation scale, patients of the TEA group were
significantly less sedated than control group at immediate postoperative only.
Conclusion: Continuous perioperative thoracic epidural Fentanyl-bupivacaine infusion was much better in
pain relief, less sedating effect and shorter duration of hospital and ICU stay than continuous perioperative fentanyl
intravenous infusion in patients undergoing major upper gastrointestinal cancer surgery.

Keywords: Thoracic epidural analgesia; Major Upper gastrointestinal However, TEA is occasionally contra indicated and may also lead
cancer surgeries; Postoperative pain; VAS scale to serious risks as, high incidence of failure rate, premature catheter
dislodgement, motor block involving lower limbs preventing early
Introduction mobilization of patient and hypotension with risk of hypervolemia
or prolonged use of vasopressors [7]. Also TEA may cause rare but
Recent estimates indicate that millions of major surgical procedures
serious a neurologic complications (hematoma, abscess and paraplegia)
are performed worldwide each year and patients undergoing
[8]. This study compares the effects of continuous perioperative
gastrointestinal surgery for malignancy are typical representatives of
thoracic epidural Fentanyl-bupivacaine infusion versus continuous
such high-risk patients [1]. Major abdominal surgeries induce neuro-
perioperative Fentanyl intravenous infusion in patients undergoing
hormonal changes responsible for postoperative pain, various organ major upper gastrointestinal cancer surgery.
dysfunctions and prolonged hospitalization. Inadequate pain control is
harmful and costly thus an appropriate pain therapy must be used to Patients and Methods
those patients (Table 1) [2]. Some of the main complications of under
This prospective randomized study was approved by the local ethics
controlled postoperative pain are cardio-circulatory complications like
committee of the South Egypt Cancer Institute, Assiut University,
tachycardia, hypertension, increase of cardiac output, increase of heart
work and dysrhythmias, increasing the risk of ischemia or myocardial
infarction in the postoperative period [3]. The presence of high-quality
*Corresponding author: Elzohry AAM, Department of Anesthesia, ICU and Pain
analgesia in the postoperative period is very important, to relieve post- Relief, South Egypt Cancer Institute, Assiut University, Egypt, Tel: 20 0106190556;
surgical pain and improve well-being, and also because inadequate pain E-mail: [email protected]
control may increase morbidity, lead to prolonged hospital stays, and Received February 15, 2018; Accepted February 19, 2018; Published February
increase medical costs [4]. 23, 2018

Citation: Elzohry AAM, Abd-El-moniem Bakr M, Mostafa GM, Mohamad MF,

Patient-controlled epidural analgesia (PCEA) is a widely used
Ahmed EH (2018) Continuous Perioperative Thoracic Epidural Fentanyl-
postoperative analgesic strategy because it is very effective and safe Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion
method of acute postoperative pain relief [5]. In these surgeries Epidural in Patients Undergoing Major Upper Abdominal Cancer Surgeries. J Pain Manage
Med 4: 132.
analgesia is effectively applied to improve perioperative pain; epidural
analgesia is coupled with improved analgesia, earlier extubation time, Copyright: © 2018 Elzohry AAM, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
better hemodynamics, less respiratory complications, and superior left
unrestricted use, distribution, and reproduction in any medium, provided the
ventricular function [6]. original author and source are credited.

J Pain Manage Med, an open access journal Volume 4 • Issue 1 • 1000132

Citation: Elzohry AAM, Abd-El-moniem Bakr M, Mostafa GM, Mohamad MF, Ahmed EH (2018) Continuous Perioperative Thoracic Epidural Fentanyl-
Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer
Surgeries. J Pain Manage Med 4: 132.

Page 2 of 6

TEA group Post- Control (n=30) TEA (n=30)

Patients characters  Control group (n=30) P. value P. value
(n=30) operative VAS Range Mean ± SD Range Mean±SD
Male 18(60%) 20(66.7%) VAS 0 h 01-Apr 2.6 ± 1 01-Feb 2.1 ± 0.9 0.049*
0.592
Female 12(40%) 10(33.3%) VAS 4 h 01-Mar 2.1 ± 0.9 01-Feb 2.6 ± 0.5 0.006*
Age (year), mean ± SD 66.4+5.61 61.73+6.07 VAS 8 h 01-Mar 2 ± 0.5 01-Feb 2.4 ± 0.5 0.002*
0.191
(range) (55-74) (55-74) VAS 12 h 02-Mar 3 ± 0.8 01-Mar 2.4 ± 0.8 0.006*
Weight (kg.), mean ± 68.7+10.01 73.67+8.58 VAS 16 h 02-Apr 3.1 ± 0.8 01-Mar 2.7 ± 1.1 0.177
0.474
SD(range) (55-88) (56-84) VAS 20 h 01-Apr 2.5 ± 0.9 01-Mar 2.3 ± 0.7 0.527
Height(cm.), mean ± 170.9+6.58 163.87+5.99 VAS 24 h 01-Apr 3.2 ± 1 02-Mar 2.7 ± 0.9 0.058
0.967
SD(range) (156-177) (154-173) VAS 28 h 02-Apr 3.1 ± 0.8 01-Mar 2.7 ± 1.1 0.177
Operative duration 5.64+0.7 5.41+0.68 VAS 32 h 01-Apr 2.5 ± 0.9 01-Mar 2.3 ± 0.7 0.527
0.196
(hours),mean ± SD (range) (4.4-7) (4.3-7) VAS 36 h 01-Mar 2.4 ± 0.6 01-Mar 2.6 ± 0.9 0.319
Type of Surgery VAS 40 h 01-Mar 2.3 ± 0.7 01-Mar 2.1 ± 0.9 0.383
pancreatic surgery 7(23.3%) 8(26.7%) 0.998 VAS 44 h 01-Mar 2.5 ± 1 01-Feb 2 ± 0.9 0.059
Lower Oesophagectomy 6(20.0%) 7(23.3%) 0.976 VAS 48 h 01-Mar 2.4 ± 1.2 01-Feb 2.5 ± 0.7 0.798
Partial Gastrectomy 17(56.7%) 15(50.0%) 0.795 VAS 52 h 01-Mar 2.5 ± 0.8 01-Feb 2.3 ± 0.7 0.178
Table 1: Patients characters. VAS 56 h 02-Mar 2.5 ± 0.5 01-Feb 2.6 ± 0.8 0.705
Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group. P. VAS 60 h 01-Mar 2.4 ± 1.2 01-Feb 2.5 ± 0.7 0.798
value<0.05 considered statistically significant. Between two groups there was no
VAS 64 h 01-Mar 2.5 ± 0.8 01-Feb 2.3 ± 0.7 0.178
significant different regarding patient's characteristics.
VAS 68 h 02-Mar 2.5 ± 0.5 01-Feb 2.6 ± 0.8 0.705
Egypt, from October 2013 till October 2015, after written consent, VAS 72 h 02-Mar 2.5 ± 0.5 01-Feb 2.6 ± 0.8 0.705
ASA II 60 patients were scheduled for elective major abdominal Table 2: Post-operative VAS.
gastrointestinal cancer surgery. Exclusion criteria were the following: Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group; VAS:
Visual Analogue Scale. P. value<0.05 considered statistically significant.
Patients who refused the study, contraindications to epidural analgesia
(coagulopathy, recent-less than 1 week-treatment with thrombolytic
or potent antiplatelet drugs as clopidogrel, and local infection), allergy 100
p value of mean MAP=0.018*
to local anaesthetic solutions or opioids. Patient whose ability to use 90
PCEA pump or who cannot be taught how to evaluate their own pain
80
intensity were also excluded from the study.
70
Preoperative data were taken within a 2 days before surgery included;
60
demographic data, medical, surgical history, physical examination and
Mean+SD

routine laboratory investigations. The day before surgery, all patients 50

Control
were taught how to evaluate their own pain intensity using the Visual 40 TEA
Analog Scale (VAS) (Table 2) [9], scored from 0-10 (where 0=no pain
30
and 10=worst pain imaginable) and how to use the PCA device (Abbott
Pain Management Provider. S. No: 96450292. Abbott Laboratory, 20
North Chicago. IL: 60064, USA)®. The Patients were randomly assigned 10
into two groups (30 patients each)by using opaque sealed envelopes
0
containing computer generated randomization schedule, the opaque 0h 1h 2h 3h 4h 5h Mean
sealed envelopes are sequentially numbered that were open before Intraoperative MAP
application of anaesthetic plan. Patients of both groups were pre-
Figure 1: Patient's intraoperative mean arterial pressure.
medicated with midazolam 0.05 mg/kg and ranitidine 50 mg. After Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group,
shifting the patient to the induction room, ECG, pulse oximeter, non- MAP: Mean Arterial Pressure; P. value<0.05 considered statistically significant.
invasive blood pressure and invasive blood pressure monitors were Between two groups there was significant difference regarding patient's
attached. Peripheral Venous line and subclavian vein catheter were Intraoperative MAP.
established-if indicated- and an infusion of lactated ringers' solution
was started as a preload (Figure 1). Standard general anaesthesia
Group 1(control group No=30) After pre-oxygenation for 3 minutes, intravenous anaesthesia
(propofol 2.5 mg/kg) induced with fentanyl 1-2 μg/kg administered
-Surgery was performed under standard general anesthesia.
over min. Tracheal intubation will be performed after adequate
-Postoperative analgesia was provided through patient Intravenous- neuromuscular blockade with cisatracurium 0.15 mg/kg. Anaesthesia
controlled analgesia (PICA) for 72 hours postoperatively. was maintained by isoflurane 1-1.5 MAC, cisatracurium 0.03 mg/
kg given when indicated. Patients were mechanically ventilated to
Group 2 (TEA group No=30) maintain ETCO2 between 35-40 mmHg. The inspired oxygen fraction
-Surgery was done under standard general anaesthesia and (FIO2) was 0.5 using oxygen-and-air mixtures. At the end of surgery
additionally Thoracic Epidural catheter was inserted and tested prior neuromuscular block was antagonized in all patients with neostigmine
induction of GA. 0.05 mg/kg and atropine 0.02 mg/kg and trachea was extubated in the
operating room. Tracheal extubation will be performed when patients
-Postoperative analgesia will provided through Patient-Controlled meet the following criteria: Hemodynamic stability, adequate muscle
Epidural Analgesia (PCEA) using TEA for 72 hours postoperatively. strength, full consciousness, and adequate ventilation breathing rate:

J Pain Manage Med, an open access journal Volume 4 • Issue 1 • 1000132

Citation: Elzohry AAM, Abd-El-moniem Bakr M, Mostafa GM, Mohamad MF, Ahmed EH (2018) Continuous Perioperative Thoracic Epidural Fentanyl-
Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer
Surgeries. J Pain Manage Med 4: 132.

Page 3 of 6

10 to 30 breaths/min, PaO2/IFO2 ≥ 80/0.4, PaCO2, 30 to 45 mmHg). mixture with lockout interval of 20 min. The analgesic regimen was
Intra operative analgesia in control group: Intra operative analgesia: By adjusted to achieve a visual analog scale score ˂3.
continuous intravenous fentanyl infusion 1 μg g/kg/hr intra operatively
Intra operative data collection includes (MAP, HR, and duration of
along with a bolus dose of fentanyl 0.5 μg/kg to maintain heart rate (HR)
anaesthesia and surgery) (Figures 3 and 4).
and blood pressure within 20% of the basal value. Rescue analgesia of
0.5 μg/g/kg was given. Fentanyl infusion was continued until shifting Post-operative all patients were admitted to surgical ICU and beside
the patient to ICU (Figure 2). routine follow up, the following were recorded:
Intra operative analgesia in TEA group: By slowly injection of • Sedation was assessed one day postoperatively by 5 points
epidural bolus dose of 0.1 ml/kg of 0.125% bupivacaine/Fentanyl 10 µg/ Sedation score (at the same time intervals of VAS) as follows
ml. After a negative response to test dose-was administered, epidural 0=aware, 1=drowsy, 2=asleep/easily respond to verbal command,
were considered to be adequately working if there is decreased pin prick 3=asleep/difficulty responding to verbal command, 4=asleep/no
sensation at the expected dermatomal level, decreased blood pressure respond to verbal command (Table 3).
from its basal level and absence of stress response to surgical incision.
• HR, MAP and were recorded every one hour in ICU.
Then, the bolus dose is followed by continuous infusion of 0.1 ml/kg of
0.125% bupivacaine/Fentanyl 8 µg/ml until the end of surgery guided • Any concomitant events like nausea; vomiting, pruritus or
by patient hemodynamic. All patients were transmitted post-operative respiratory depression (decrease oxygen saturation ≥ 90%) were
ICU. recorded postoperatively
Thoracic epidural catheter • Duration of hospital and ICU (Table 4).
Under strict aseptic precautions thoracic epidural was performed • Visual analogue scale- every 4 hours for 3 days-for pain
using a 16 gauge Tuhy epidural needle by a paramedian approach. T7- measurement. And total doses of Fentanyl consumption (both
T8 or T8-T9 interspace was chosen for the injection (with air) after skin intra and post-operative) were calculated (Table 5).
wheal of lidocaine local anesthetic 2%. The catheter was introduced
approximately 4 cm into the epidural space. The epidural space was 100
identified by the loss of resistance technique. A 3 ml test dose of 2% p value of mean HR=0.247
Lidocaine with 1: 200,000 Adrenaline was given after the placement of 90
the epidural catheter.
Patient-controlled I.V analgesia 80
Mean+SD

Control
Using Fentanyl 10 μg/ml solutions through PCA device that 70
TEA
programmed to give a bolus dose 2 ml/dose with a minimal lockout
interval of 10 min with no background infusion. The analgesic regimen 60
was adjusted to achieve a visual analog scale score ˂3.
Patient-controlled epidural analgesia 50
Day1 Day2 Day3
In the PCEA group, postoperative pain treatment was achieved by Post-operative MAP
background epidural infusion of 0.1 ml/kg/h of the mixture 1.25 mg/ Figure 3: Post-operative MAP.
ml bupivacaine plus 5 μg/ml Fentanyl, and 3 ml as top up dose of this Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group,
MAP: Mean Arterial Pressure. P. value<0.05 considered statistically significant.
Between two groups there was no significant difference regarding patient's
post-operative MAP.
120
p value of mean HR=0.016*

100 90
p value of mean HR=0.148

80 85
Mean+SD

80
60
Mean+SD

Control
TEA 75
Control
40
70 TEA

20
65

0 60
0h 1h 2h 3h 4h 5h Mean Day1 Day2 Day3
Intraoperative HR Post-operative HR
Figure 2: Intraoperative Heart Rate. Figure 4: Post-operative HR.
Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group; Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group,
H.R.: Heart Rate. P. value <0.05 considered statistically significant. Between H.R: Heart Rate. P. value <0.05 considered statistically significant. Between
two groups there was significant difference regarding patient's Intraoperative two groups there was significant difference regarding patient's post-operative
H.R. H.R.

J Pain Manage Med, an open access journal Volume 4 • Issue 1 • 1000132

Citation: Elzohry AAM, Abd-El-moniem Bakr M, Mostafa GM, Mohamad MF, Ahmed EH (2018) Continuous Perioperative Thoracic Epidural Fentanyl-
Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer
Surgeries. J Pain Manage Med 4: 132.

Page 4 of 6

Post-operative Control (n=30) TEA (n=30) P analgesia was better and sedation scores were significantly decreased
sedation score Range Mean ± SD Range Mean ± SD value especially at immediate postoperative period in patients of the TEA
0h (2–1) 2 (1–1) 1 0.00* group in comparison to control group. We believe in the concept of
4h (2–1) 2 (1–1) 1 0.00* preemptive analgesia which is to prevent altered sensory processing.
8h (2–1) 2 (1–1) 1 0.956 Therefore we started our pain control strategy in intraoperative period;
12 h (1–1) 1 (1–1) 1 0.943 preemptive may not simply mean “before incision” An insufficient
16 h (1–1) 1 (1–1) 1 0.948 afferent blockade cannot be preemptive, even if it is administered before
20 h (1–1) 1 (1–1) 1 0.943 the incision [10]. PCA is considered one of best methods in controlling
24 h (1–1) 1 (1–1) 1 0.956 pain and can be used either intravenously or epidural. Advantages
Table 3: Post-operative sedation score.
of PCA over conventional pain management are that the therapy is
Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group, P individualized to the patient. Patients are the best to assess their pain
value<0.05 considered statistically significant. and they can get medication as and when required by pressing a button of
PCA pump. Thus it reduces overdose and also reduces nursing aid [11].
  Control (n=30) TEA (n=30) P. value
No complication 17(56.7%) 24(80%) 0.319 We used in this study PCEA using both bupivacaine and fentanyl
Vomiting 3 (10%) 0(0%) 0.383 because Epidural LA drugs administered alone have never become
Pruritus 2 (6.6%) 0(0%) 0.059 widely used for routine postoperative analgesia because of the
Respiratory depression 4 (13%) 1(3.3%) 0.798 significant failure rate resulting from regression of the sensory block and
Bradycardia 4 (13%) 5(16.7%) 0.178 the unacceptable incidence of motor blockade and hypotension [12].
Table 4: Post-operative complication. Consistent with us, Mann et al, who compared the effectiveness
Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group, P. on postoperative pain and safety of PCEA and intravenous PCA after
value<0.05 considered statistically significant. There was no significant difference
between two groups. major abdominal surgery, they found pain relief was better at rest and
after coughing in the PCEA group during the five postoperative days
Control (n=30) TEA (n=30) P. [13]. And in the study done by Behera et al, the number of patients with
 
Range Mean ± SD Range Mean ± SD value analgesic failure was significantly less in PCEA group as compared to IV
ICU STAY 03-Nov 7.47 ± 2.16 03-Aug 5.6 ± 1.57 0.000* PCA group [14]. Moreover a study performed on patients undergoing
Hospital stay Mar-31 22.13 ± 7.62 Oct-25 18.13 ± 4.12 0.014* upper abdominal surgery; despite the infusion of bupivacaine 37.5
Post op. ± 50 mg/h via a thoracic epidural 30% of patient's required opioid
Fentanyl 753.33 ± supplementation for inadequate analgesia and 80% had significant
1200-2000 1646.67 ± 234.5 600-1000 0.000*
(mic/72h) 122.43
consumption hypotension [15]. So, opioids must be added either morphine or
Intra op. fentanyl and our choice of fentanyl based on the higher lipophilicity of
Fentanyl fentanyl that makes it shorter duration of action, lower incidence of side
280-480 384.8 ± 92.5 65.6-120 80.9 ± 22 0.000*
(mic/72h) effects, and reduced risk of respiratory depression [16].
consumption

Table 5: ICU, Hospital stay, ICU stay and Fentanyl consumption.

Fentanyl is more preferred than morphine as proved by a study
Data are expressed as mean ± SD, TEA: Thoracic Epidural Analgesia Group, ICU: conducted by Teng et al. who concluded that patients receiving epidural
Intensive Care Unit P. value <0.05 considered statistically significant. There was fentanyl bupivacaine PCA experienced better overall pain relief, while
significant different between two groups. morphine PCA, either epidural or intravenously, caused more side
effects [17].
Statistical analysis
The application of opioids by epidural analgesia delivers the
The required sample size was calculated using Epi Info software drug close enough to the spinal cord so that the opioids can inhibit
version 7 (CDC, 2012)®. Using post hoc power analysis with accuracy pain transmission from afferent nerves to the central nervous system
mode calculations with VAS as the primary objective and therefore, through interaction with pre- and postsynaptic opioid receptors in
it was estimated that minimum sample size of 29 patients in each the dorsal horn When the same amount of an opioid is used, epidural
study group would a chive a power of 80% to detect an effect size application of PCA should achieve more effective analgesia than
of 0.8 in the outcome measures of interest, assuming a type I error systemic administration [18].
of 0.05. All analyses were performed with the SPSS 20.0® software.
Categorical variables were described by number and percent (N, %), At the end of the 24 h postoperatively there was no significant
where continuous variables described by mean and standard deviation difference in VAS between both groups as the plasma level of fentanyl
(Mean, SD). And Mann-Whitney test were used to compare between was constant in controlling pain in both groups.
two groups while Chi square test was used for qualitative data. Where Very similar to our results a study done by Privado et al, comparing
compare between continuous variables by t-test. P was considered epidural versus intravenous fentanyl for postoperative analgesia
significant if 60.05 at confidence interval 95%. following orthopedic surgery, they found that epidural fentanyl is more
Discussion efficient than intravenous fentanyl administration during first day
postoperative and no significant difference between both groups after 24
Since the discovery of a pain inhibitory system modulated specially h [19]. But against us, Welchew and Breen who found that both routes
in the spinal cord by neurotransmitters like endorphins, serotonin and of fentanyl administration resulted in equally satisfactory analgesia but
others, there were possibilities of using substances 8-10 that imitate the total dose of fentanyl in intravenous group was twice the total dose
the action of these inhibitory neurotransmitters in the epidural or of fentanyl in epidural group during the first 24 h postoperatively [20].
subarachnoid spaces as means for controlling postoperative pain [9]. TEA by its sympathetic inhibition may cause hypotension. As found
This randomized clinical study showed that the quality of postoperative in a study conducted by Komatsu et al. who agree with us- found five

J Pain Manage Med, an open access journal Volume 4 • Issue 1 • 1000132

Citation: Elzohry AAM, Abd-El-moniem Bakr M, Mostafa GM, Mohamad MF, Ahmed EH (2018) Continuous Perioperative Thoracic Epidural Fentanyl-
Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer
Surgeries. J Pain Manage Med 4: 132.

Page 5 of 6

episodes of postoperative hypotension occurred in the PCEA group Conclusion

versus none in the PCA group. The patients were treated by simple fluid
loading [21]. In the present study, the incidence of side effects were This study concluded that both Continuous perioperative thoracic
increased in control group compared to TEA group, but the difference epidural Fentanyl-bupivacaine infusion and Continuous perioperative
was statistically significant only in sedation. fentanyl intravenous infusion in patients undergoing Major Upper
gastrointestinal cancer Surgery were effective in pain relief but
Epidural administration of opioids was associated with side Continuous perioperative thoracic epidural infusion was much better
effects like sedation, delayed respiratory depression, nausea, vomiting, in pain relief with less sedating effect.
pruritus, urinary retention. These sideeffectsarecausedbythepresence
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Bupivacaine Infusion vs. Continuous Perioperative Fentanyl Intravenous Infusion in Patients Undergoing Major Upper Abdominal Cancer
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