Lumbar epidural morphine infusion has been compared to intravenous opioid analgesia in a retrospective review of 91 children undergoing cardiac surgery. The efficacy of caudal epidural morphine was compared prospectively with intravenous morphine in 32 children following open cardiac surgery. The control group received intravenous morphine alone for postoperative analgesia. Supplemental doses of intravenous morphine were given to children in both groups as needed, at which times pain scores were recorded. Children having received caudal morphine required significantly less intravenous morphine and had significantly lower pain scores postoperatively than patients in the control group.
Epidural anesthesia is associated with fewer opioid related side effects.
Bowel function returns more rapidly following surgery with an epidural anesthetic compared than with intravenous analgesics. A review of sixteen studies comparing epidural and systemic analgesia found that all eight studies with epidural catheter placement above T12 showed more rapid recovery of bowel function . Epidural fentanyl following thoracotomy has been shown to lower the incidence of nausea, duration of ileus, and hospital length of stay as compared to intravenous fentanyl. Postoperative interstital edema might also be reduced when epidural anesthesia is used in adult patients undergoing heart surgery. Rein et al.