A comparison of the effects on postoperative pain relief of epidural analgesia started before or after surgery

Abstract

In a randomized, prospective clinical study pain relief and pulmonary function were compared after upper abdominal surgery when thoracic epidural analgesia was instituted either before or after surgery. Twenty-six patients admitted for surgery to treat gastro-oesophageal reflux received thoracic epidural analgesia as an adjunct to general anaesthesia either before or after surgery. Twelve patients received epidural mepivacaine 20 mg mL(-1) and morphine perioperatively. Another 14 patients received an epidural bolus of bupivacaine 2.5 mg mL(-1) and morphine after skin closure. Bupivacaine 2.5 mg mL(-1) with morphine was adminstered to all patients for three postoperative days. No intergroup differences were found regarding pain at rest and mobilization. The requirement for additional analgesics was similar in both groups as well as peak expiratory flow. Thoracic epidural analgesia that had already been induced before surgery, and was continued into the postoperative period, does not seem to add any advantage regarding pain relief and lung function compared with thoracic epidural analgesia instituted in the immediate postoperative period.

Effects of anesthesia on pain after lower-limb amputation

“…Gottschalk and Frank [9] found that intraoperative attenuation of noxious stimuli with epidural block reduced pain and wound hyperalgesia for three weeks after surgery in one patient. Flisberg et al [10] and Dahl et al [11] reported that epidural analgesia started in the postoperative period was as effective as epidural analgesia started preoperatively and continued into the postoperative period.…”

Patterns in current anaesthesiological peri‐operative practice for colonic resections: a survey in five northern‐European countries

“…Furthermore, it improves exercise capacity and quality of life (12) and dampens the surgical stress response (24), which contributes to a reduction in post‐operative insulin resistance. When the epidural should be activated is currently an unresolved issue, although a recent randomized, prospective trial suggests activation before surgery has no advantage over post‐operative activation (25). Bupivacaine and ropivacaine are most frequently used in epidural anaesthesia in all countries.…”

Local metabolic changes in subcutaneous adipose tissue during intravenous and epidural analgesia

“…A VAS score below four and a patient satisfied with the analgesia were our endpoints. We have earlier examined the extension of the epidural anesthesia (30, 31) in the same type of patients and found a constant level of epidural anesthesia for several days. The same bupivacaine concentration was used but the morphine content was higher (0.125 mg ml −1 vs. 0,05 mg ml −1 ) than in the present study.…”