Lumbar epidural LA plus opioid versus systemic opioid

Lumbar epidural LA plus opioid versus systemic opioid

• One study compared bupivacaine (7.5 mg/ml; 20 ml) plus morphine (2 mg), administered pre-operatively via the epidural catheter (L3/4 or L4/5), followed by continuous infusion with bupivacaine (1.25 mg/ml) plus morphine (0.05 mg/ml) at 4 ml/h for the first 24 h postoperatively and bupivacaine (0.625 mg/ml) plus morphine (0.05 mg/ml) at 4 ml/h until 48 h (n=10) versus GA plus postoperative systemic opioid (5 mg IV morphine, 0.125 mg/kg IM morphine) (n=10) ((Møiniche 1994); LoE 1)
  
• A second study compared postoperative epidural infusion (L2/3 or L3/4) of ropivacaine (2 mg/ml) plus morphine (0.02 mg/ml) (n=15) versus ropivacaine (1.25 mg/ml) plus morphine (0.02 mg/ml) (n=15) at 8 ml/h, with control (saline) (n=15). All groups received IV PCA morphine (1 mg/ml, 6-min lockout) ((Axelsson 2005); LoE 1)
  
• In another study, postoperative infusion with bupivacaine (0.5%) plus fentanyl (10 ?g/ml) at 3–5 ml/h via an epidural catheter (L2/3 or L3/4) (n=26) was compared with IV fentanyl (10 ?g/ml) infused postoperatively at 100 ?g/h (n=25) ((Sharrock 1994); LoE 1)
  
• The last study compared continuous infusion of bupivacaine (0.125%), sufentanil (0.1 ?g/ml) and clonidine (1 ?g/ml) via a lumbar epidural catheter (L2/3 or L3/4) peri-operatively (n=15) versus IV PCA-morphine (2 mg/ml, 1.5 mg, 8-min lockout), available during the first 48 h postoperatively (n=15) ((Singelyn 1998); LoE 1)