Assessment of Inflammatory Markers in the Epidural Infusion of Bupivacaine-Fentanyl Compared to Morphine Bolus Injection in Gastrointestinal Cancer Surgeries

Background: Gastrointestinal surgery is one of the procedures that result to produce inflammatory reactions and pain to patients. Administrate of high-safe analgesia in surgery is very essential, to reduce pain and improve inflammatory reactions. Objectives: The present study compared inflammatory markers and pain relief with the epidural infusion of bupivacaine-fentanyl and intravenous morphine bolus in gastrointestinal cancer surgeries. Methods: This randomized control clinical trial study was carried out from December ۲۰۱۸ to October ۲۰۲۰, on ASA I and II patients aged between ۳۰-۸۰ years who referred for gastrointestinal cancer surgery. Cases were randomly distributed into two groups. Group I received epidural catheter with bupivacaine (۱۸ cases), and group II received fentanyl and morphine bolus injection (۱۸ cases). On the first and second days post-operation, data on pain scores based on visual analogue scale (VAS) score, inflammatory markers (procalcitonin [PCT] and C-reactive protein [CRP]), platelet (PLT), white blood cells (WBCs), and erythrocyte sedimentation rate (ESR) was recorded. Results: The mean age was ۵۲.۲۱±۱۶.۱۳ years (۴۱.۶% male, ۵۸.۴ female). The mean of ESR, CRP and PCT postoperative were significantly higher than preoperative (P < ۰.۰۵). There were no differences between the two groups regarding PLT, ESR, CRP, and PCT preoperative postoperative (P > ۰.۰۵). The mean of pain was less in the epidural group than in the morphine group postoperative (P = ۰.۰۲). Conclusion: The results showed that epidural fentanyl-bupivacaine infusion was more effective in pain reduction than the intravenous infusion of morphine in cases undergoing gastrointestinal cancer operation. However, both analgesic approaches were similar in inflammatory functions.

Keywords:

Inflammatory Biomarker , Pain , Epidural Analgesic , Morphine