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Abstract
Postoperative pain management is an important component in recovery. Epidural opioids are commonly used together with local anesthetics as an effective combination for perioperative analgesia due to its synergistic effect. Epidural morphine is used widely because it has a prolonged analgesic effect. However, side effects such as nausea, pruritus, respiratory depression and urinary retention can be more distressing than the pain itself. Many drugs have been tried to minimize morphine induced side effects such as naloxone, nalbuphine, dexamethasone, DROPeridol, anti-histamines and
propofol. We designed this study to determine whether epidural naloxone would preserve analgesia while minimizing side effects of epidural morphine and tried to determine the optimum dose of epidural naloxone. We have studied eighty female patients American Society of Anesthesiology (ASA) physical status I and II scheduled for elective hysterectomy with a pfannenstiel incision. All patients had a 20 G epidural catheter to be inserted at L3-L4 lumbar vertebrae under aseptic precautions after local infiltration. Immediately after insertion, a test dose of 15 ug epinephrine 1: 200,000 was given to detect intravascular injection. The 15 ug of epinephrine if injected intravascularly should produce an increase in heart rate of 20% of baseline or more with or without hypertension. Five minutes latter, 3 ml of hyperbaric bupivacaine 0.5% was injected to detect intrathecal injection that would produce spinal anesthesia. Precautions as aspiration prior to insertion and incremental dosing were considered to avoid inadvertent intrathecal injection.