Epidural morphine vs local anesthetics in gynecologic oncology surgery: Indian audit

Epidural analgesia with local anaesthetics while recommended by enhanced recovery pathways can exacerbate haemodynamic instability. Epidural morphine provides profound analgesia owing to its hydrophilic properties. This retrospective analysis was aimed to compare the analgesic efficacy and adverse effects of epidural morphine with that of local anaesthetic infusions after major gynaecological oncological surgery.

This audit included all open surgeries for gynaecological malignancies lasting for more than 4 hours conducted between June 2022 and March 2024. After ethical clearance, prospectively maintained data from the Acute Pain Service was divided into two, Group L (local anaesthetics) and Group M (morphine), according to the epidural drug regimen. Outcomes assessed included pain scores on postoperative days 1 to 3, need for rescue analgesia, incidence of adverse effects, interruption of epidural drug therapy, vasopressor support beyond postoperative day 1 and length of hospital stay. Students t test and chi squared tests were used where appropriate.

A total of 186 patients were included with 138 patients in Group L and 58 in Group M. There were no significant differences in the mean age, blood loss or duration of surgery. The mean resting and dynamic pain scores and need for rescue analgesia were comparable between the two groups. The incidence of adverse effects and epidural interruption were also comparable. There were no significant differences in vasopressor requirement and length of hospital stay between the two groups.

The analgesic efficacy and adverse effect profile of epidural morphine was found to be comparable to local anaesthetic infusions.