Comparison of systemic morphine, nalbuphine, and epidural analgesia on acute and chronic postoperative pain in laparoscopic colorectal surgery: a randomized controlled trial

This study aimed to assess the effectiveness of diverse postoperative analgesic tech-niques in laparoscopic colorectal surgery and ascertain whether systemic administration of nalbuphine is a suitable alternative for this type of procedure. Sixty-nine patients suffering from colorectal cancer and undergoing laparoscopic surgery were randomly divided into three groups (n = 23, per group). Group R received patient-controlled epidural analgesia (PCEA) with ropivacaine. Group M received patient-controlled intravenous analgesia (PCIA) with morphine. Group N received PCIA with nalbuphine. Pain at rest (PAR), movement-evoked pain (MEP), stress hormone and any complications during the 72 hours after surgery were recorded. Additionally, chronic post-surgical pain (CPSP) at 3 months and 6 months were also recorded. There was no significant difference in PAR among the 3 groups. However, patients in Group N had a higher intensity of MEP compared to those in Group R after surgery (p < 0.05). There was no significant difference in CPSP at 6 months among the 3 groups (p > 0.05), but the incidence of CPSP at 3 months was higher in Group N (p = 0.01, as compared to Group R). The occurrences of pruritus and postoperative nausea and vomiting (PONV) were observed to be considerably greater in Group M as compared to the other two groups (p < 0.05). In conclusion, PCEA is more effective than PCIA with nalbuphine in reducing postoperative MEP and CPSP at 3 months after laparoscopic colorectal surgery. However, there was no significant difference between PCEA and PCIA with nalbuphine in reducing CPSP at 6 months. Although morphine and nalbuphine have the similar analgesic effects, morphine is associated with more side effects. Therefore, PCIA with nalbuphine might be a good option for patients who are not suitable for PCEA or have a high risk for PONV or pruritus.

Postsurgical pain; Complication; Epidural analgesia; Nalbuphine; Morphine; Colorectal surgery

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