584 1984;63:583-92
RAWAL ET AL.
Table 1. Patient Data
Intramuscular morphine plus epidural Epidural morphine plus intramuscular
saline (n = 15) saline (n = 15)
Mean f SEM Range Mean * SW Range
31.1 2 2.10 23-47 36.7 f 2.10 21-49
121.9 f 6.0 94-184 121.9 2 3.4 106-152
168.6 f 2.0 159-184 169.8 2 1.5 162-183 Age (Yr)
Height (cm)
Weight (kg)
Broca index
Sex M/F 4/11 3/12
1.8 f 0.07 1.5-2.4 1.8 f 0.05 1.5-2.1
Duration of 70 f 3.6 50-105 69.0 2 4.7 55-115
operation (min)
anesthesia (min)
Duration of 100.3 f 4.8 70-135 111 & 5.0 80-150
Smokers 4 (20%) 5 (33.3%)
Methods
Thirty patients scheduled for elective gastroplasty for
weight reduction participated in the study, which was
approved by the local ethics committee. Informed
written consent was obtained from each patient. To
compare the analgesic effects of intramuscular and
epidural morphine on postsurgical pain, the patients
were randomly divided into two groups (A and B) of
15 each. The patients were included in the study if
their Broca index values were 1.5 or above (6). This
was calculated as follows:
weight (kg)
height (cm) - 100 *
Broca index =
On being accepted for surgery, the patients were
given oral and written information on the beneficial
postoperative results of preoperative preparation. This
included encouragement to increase their physical ac-
tivity in order to improve their general condition, to
perform coughing and deep breathing exercises (ap-
propriately illustrated), to adhere to a diet schedule,
and to reduce or, preferably, stop smoking. They were
also informed about the benefits of early postopera-
tive ambulation. Each patient was informed about the
anesthetic management on the day before operation
(thoracic epidural blockade combined with light en-
dotracheal anesthesia) and given instructions about
marking a linear visual analog pain scale. The phy-
siotherapist also visited the patient the day before
operation and demonstrated coughing and deep
breathing exercises, and again emphasized the im-
portance of early postoperative ambulation. None of
the patients had a history of cardiopulmonary or
thromboembolic disease. Preoperative chest radi-
ographs were taken to rule out cardiac enlargement
and to evaluate any parenchymal changes. In addition
to measuring serum electrolytes, blood samples were