BACKGROUND: Postoperative ileus is a universal complication after major intraabdominal surgery. Choice of postoperative analgesia may affect the rate of functional recovery of bowel. Epidural analgesia with morphine and bupivacaine is a popular method for pain relief. However little is known about the effects of this regimen on bowel motility. METHODS: Forty patients undergoing partial or total gastrectomy were randomized into two groups. All groups received a standardized general inhalation anesthesia with enflurane. Control group received traditional intramuscular(IM) administration of meperidine for the postoperative analgesia. Experimental group received a bolus of epidural 0.5% bupivacaine 10 ml followed by continuous epidural infusion of 0.21% bupivacaine with 0.01% morphine, started at the end of operation with the basal infusion rate of 1 ml/hours, bolus 1 ml, and ldegrees Ckout interval 30 min during 48 hr. We compared the analgesic effect, side effects and restoration of bowel function(first passage of flatus and feces)between two groups. Postoperative pain was assessed using the 10 cm visual analog pain scale (0=no pain, 10=worst imaginable pain) at rest. Scores were taken at 1, 6 hours after operation and 7 AM, 6 PM of the 1st postoperative day and 7 AM of the 2nd postoperative day. RESULTS: Experimental group revealed superior analgesia(p<0.005) but had a greater incidence of nausea, pruritus and urinary retention. No significant difference was found in restoration of bowel function between two groups. CONCLUSION: There was no superior effect of epidural analgesia with morphine and bupivacaine on bowel motility after gastrectomy than the effect of traditional IM meperidine administration.
Analgesia ; Analgesia, Epidural* ; Anesthesia, Inhalation ; Bupivacaine* ; Enflurane ; Flatulence ; Gastrectomy* ; Humans ; Ileus ; Incidence ; Meperidine ; Morphine* ; Nausea ; Pain Measurement ; Pain, Postoperative ; Pruritus ; Urinary Retention

Propofol is an anesthetic agent that gained wide use because of its fast induction of anesthesia and rapid recovery post-anesthesia. However, previous studies have reported immediate neurodegeneration and long-term impairment in spatial learning and memory from repeated neonatal propofol administration in animals. Yet, none of those studies has explored the sex-specific long-term physical changes and behavioral alterations such as social (sociability and social preference), emotional (anxiety), and other cognitive functions (spatial working, recognition, and avoidance memory) after neonatal propofol treatment. Seven-day-old Wistar-Kyoto (WKY) rats underwent repeated daily intraperitoneal injections of propofol or normal saline for 7 days. Starting fourth week of age and onwards, rats were subjected to behavior tests including open-field, elevated-plus-maze, Y-maze, 3-chamber social interaction, novel-object-recognition, passive-avoidance, and rotarod. Rats were sacrificed at 9 weeks and hippocampal protein expressions were analyzed by Western blot. Results revealed long-term body weight gain alterations in the growing rats and sex-specific impairments in spatial (female) and recognition (male) learning and memory paradigms. A markedly decreased expression of hippocampal NMDA receptor GluN1 subunit in female- and increased expression of AMPA GluR1 subunit protein expression in male rats were also found. Other aspects of behaviors such as locomotor activity and coordination, anxiety, sociability, social preference and avoidance learning and memory were not generally affected. These results suggest that neonatal repeated propofol administration disrupts normal growth and some aspects of neurodevelopment in rats in a sex-specific manner.
alpha-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic Acid ; Anesthesia ; Animals ; Anxiety ; Avoidance Learning ; Blotting, Western ; Body Weight ; Humans ; Injections, Intraperitoneal ; Interpersonal Relations ; Learning ; Male ; Memory* ; Motor Activity ; N-Methylaspartate ; Propofol* ; Rats* ; Weight Gain