Vol. 3, Issue 4, Part B (2019)

Background and Objective: Effective postoperative pain management is crucial for optimal recovery. Epidural analgesia using local anesthetics with opioids and intravenous patient-controlled analgesia (IV PCA) are commonly employed techniques. This study aims to compare the analgesic efficacy, side effects, and patient satisfaction between epidural bupivacaine with fentanyl and IV PCA in patients undergoing major abdominal surgery.

Materials and Methods: A prospective, randomized study was conducted on 50 patients aged 18-65 years undergoing elective abdominal surgery under general anesthesia. This study was conducted at the department of Orthopedics, Dhanlakshmi Srinivasan Medical College and Hospital, Perambular, Tamil Nadu, India from July 2018 to June 2019. Patients were randomly divided into two groups (n=25 each): Group E received epidural 0.125% bupivacaine with fentanyl (2 µg/mL), while Group I received IV PCA with morphine. Postoperative pain scores using the Visual Analog Scale (VAS), total analgesic consumption, incidence of side effects, and patient satisfaction scores were assessed at 2, 6, 12, and 24 hours postoperatively.

Results: Group E showed significantly lower VAS scores at all time intervals compared to Group I (p<0.05). The total morphine consumption in Group I was significantly higher than the total fentanyl used in Group E (p<0.01). Incidence of nausea and vomiting was higher in Group I, whereas Group E reported more cases of pruritus. Patient satisfaction scores were significantly higher in the epidural group (p<0.05).

Conclusion: Epidural bupivacaine with fentanyl provides superior postoperative analgesia, reduced opioid consumption, and greater patient satisfaction compared to intravenous PCA with morphine. It also demonstrates a favorable side effect profile, making it a preferable modality for postoperative pain management in major abdominal surgeries.