BACKGROUND: Local anesthetics and opioids have been widely used for epidural patient controlled analgesia (PCEA). Epinephrine also has been known to potentiate the analgesic effect of epidurally administered local anesthetics or opioids. The aim of this study was to compare analgesic effects and side effects of PCEA with ropivacaine mixed with either morphine, fentanyl, or epinephrine.

METHODS: Sixty-seven subtotal gastrectomy patients with postoperative analgesia by PCEA were randomly allocated into group M; 0.2% ropivacaine and 40µg/ml morphine, group F; 0.2% ropivacaine and 4µg/ml fentanyl, or group E; 0.2% ropivacaine and 2µg/ml epinephrine. The visual analogue scale (VAS) for pain and side effects at 6 and 24 hours postoperatively were measured.

RESULTS: The VAS scores were significantly higher in group E compared to group M and F at 6 hours postoperatively and to group F at 24 hours postoperatively. The total doses of PCEA in M group were lower than those of F and E groups. The incidence and severity of postoperative nausea were higher in group M compared to group F, E at 6 and 24 hours postoperatively.

CONCLUSIONS: Epinephrine provided lesser side effects and higher VAS score compared to fentanyl or morphine mixed with ropivacaine PCEA. Epinephrine instead of opioids may be used for PECA without significant side effects, however the dose adjustment of PCEA may be needed for adequate analgesia.