Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery

Abstract

Summary The present study tested the hypothesis that patients receiving epidural bupivacaine before surgery would require less morphine postoperatively and/ or report less intense pain than patients receiving epidural bupivacaine after incision but before the end of surgery. Forty-nro patients (ASA class I-III) scheduled for lower abdominal surgery were randomly assigned to I of 2 groups of equal size and prospectively studied using a double-blind, placebo-controlled crossover design. Epidural catheters were placed in the Tlz-Ll or L1-L2 interspaces pre-operatively, the position of the catheter was confirmed with 3Vo chloroprocaine with epinephrine L :200,000, and sensory testing was carried out until levels had receded to below T12. Group I received 15 ml of 0.5Vo epidural bupivacaine injected 35 min before incision followed by 15 ml of epidural normal saline 30 min after incision. Group 2 received 15 ml of epidural normal saline injected 37 min before incision followed by 15 The results suggest that single-shot pre-emptive epidural local anaesthesia is associated with a short-term morphine-sparing effect which is most pronounced between 12 and 24 h after surgery. Extending the pre-operative blockade into the postoperative period may prolong the initial advantage conferred by pre-emptive epidural local anaesthesia.

Psychophysical evaluation of the descriptors of pain in the postoperative

“…vague, painful, sensitive, annoying and tiresome (11) . However, some of the most attributed descriptors belonged to the Portuguese version of the MPQ (7) and described different dimensions of the painful experience, as observed in other studies (9)(10)(11) .…”

High dose alfentanil pre-empts pain after abdominal hysterectomy

“…(Katz 1995;Yashpal et al 1996). Our previous work in this area suggests that the epidural route (Katz et al 1992a(Katz et al , 1994 may be more effective than other routes (Kavanagh et al 1994b) …”

“…(Ejlersen et al 1992\ or epidural analgesia/anaesthesia. (Katz et al 1992a(Katz et al , 1994 (Richmond et al 1993) …”

Analgesia preemptiva

“…For the same type of surgery, Dakin et al 53 administered 15 mg of 0.5% spinal hyperbaric bupivacaine before or after surgery with a sensory block from T 3 to S 5 without preemptive effects. However, when administering 15 ml of epidural 0.5% bupivacaine in patients submitted to abdominal surgeries, Katz et al 54 observed that pain scores using McGill's questionnaire and morphine consumption were lower for the group medicated before surgical incision. Aguilar et al 55 administered 0.5% thoracic epidural bupivacaine with epinephrine in patients submitted to pulmonary resection without differences between groups receiving medication before or after incision as to analgesic consumption, VAS and verbal scale and the preemptive effect could not be demonstrated.…”