Comparison of Bolus Bupivacaine, Fentanyl, and Mixture of Bupivacaine with Fentanyl in Thoracic Epidural Analgesia for Upper Abdominal Surgery

Introduction: Thoracic segmental epidural analgesia despite its technical difficulty and time consumption provides better analgesia and has a beneficial effect on the post-operative pulmonary and metabolic function; immunological and stress response. Aims and Objectives: To study the efficacy of fentanyl for pain relief of inpatients after upper abdominal procedures and compare with bupivacaine alone and with bupivacaine and fentanyl combination (1) To find out the synergistic effect of bupivacaine with fentanyl. (2) Assessment of severity of pain at rest and during function, intensity of post-operative pain relief, duration of postoperative pain relief, and the incidence of side effects. Materials and Methods: After institutional approval, patients were allocated into three groups of 30 patients each. Group A patients receiving 10 ml of 0.25% bupivacaine epidurally; Group B patients receiving 10 ml of fentanyl 50 μg epidurally, and Group C patients receiving 10 ml of 0.25% bupivacaine with fentanyl 50 epidurally. Required parameters were assessed. Result: Combination of bupivacaine with fentanyl in thoracic epidural analgesia after upper abdominal surgery, showed better analgesic efficacy, synergistic effect, short onset of action, and longer duration of action (ranges from 150 to 280 min) with minimal side effects. Conclusion: The thoracic epidural is strongly recommended technique for post-operative pain relief after upper abdomen surgery.