Comparison of epidural levobupivacaine and levobupivacaine morphine on postoperative analgesia in children undergoing major abdominal surgery

In this study, we aimed to compare the effects of epidural levobupivacaine and levobupivacaine-morphine administration on postoperative analgesia in children undergoing major abdominal surgery. After the approval by Ethic Committee in the Faculty of Medicine of Cukurova University informed consent of parents were taken, 47 children with American Society of Anesthesiologists (ASA) physical status group I-II and age between 1-14 years undergoing major urological and intestinal surgery were included. In cases; following the induction of anesthesia and tracheal entubation ,patients were placed into left lateral decubitis position and an epidural catheter (22-24 G) was inserted by using Tuohy needle (19-20 G). Patients were randomly divided into two groups. Epidural block was performed with levobupivacaine (% 0,125)-morphine (30 mcg/kg) in group I patients and sole levobupivacaine (% 0,25) in group II patients in each with a volume of 0,7 ml/kg. In these cases preoperative and peroperative 5th, 10th, 15th, 30th, 45th, 60th, 90th, 120th, 150th, 180th minutes sevofluran concentration, systolic and diastolic blood pressure and heart rate were recorded. Postoperative pain (CHEOPS) and sedation (5 point sedation test) scores were evaluated on 5th, 10th, 15th, 30th, 45th minutes and 1st, 2nd, 4th, 6th, 12th, 24th hours and recorded. Side effects and the number of patients who required rescue analgesic were recorded. Demographical datas were similar between the two groups. Intraoperative, sevoflurane concentrations recorded on 10th, 30th minutes were lower in group I than group II (p<0,05). In the first 24 hour of postoperative period, the number of patients who required rescue analgesic was 7 in group I and 18 in group II (p=0,003). The duration of postoperative analgesia was significantly longer in group I, than group II (p=0,002). Postoperative Chidren?s Hospital of Eastern Ontorio Pain Scale (CHEOPS) outcomes evaluated on, 5th, 10th, 15th, 30th, 45th, 60th minutes and 2nd, 24th hours were lower in group I than group II (p<0,05). Sedation scores evaluated on the postoperative 10th, 15th, 30th, 45th, 60th minutes were higher in group I than group II (p<0,05). Hypotension, bradycardia or respiratory depression were not observed in two groups. n conclusion; we concluded that epidural levobupivacaine and levobupivacaine plus morphine produced effective postoperative analgesia in patients undergoing major abdominal surgery. Epidural levobupivacaine?morphine combination increased sedation scores, reduced perioperative requirements of sevoflurane and postoperative rescue analgesic, provided long term postoperative analgesia in children.