Abstract
Pain management is a crucial component in the care of the postoperative patient. Although pre-emptive analgesia is commonly used for the management of postoperative pain, timing the analgesic administration is unclear. This study was designed to compare the efficacy of pre-emptive epidural analgesia (EA) with preventive EA in the patients undergoing major gynecologic surgery. A randomized, double-blinded trial was performed in 50 women of physical status American Society of Anesthesiologists (ASA) 1-3 undergoing major gynecologic surgery. Prior to induction of general anesthesia an epidural catheter was inserted in the patients of the two groups. Patients were allocated randomly into one of two groups; pre-emptive group (n = 25) received 12 ml of 0.125% bupivacaine and 50 µg fentanyl epidurally 20 min before the incision of surgery and the preventive group (n = 25) received the same of agents 20 min before the end of surgery via the epidural catheter. Preventive compared to pre-emptive EA had a significantly increased interval between the analgesic requests (P<0.001). The preventive group compared to the pre-emptive group had significantly decreased postoperative visual analog scale (VAS) in post anesthesia care unit (PACU) and up to 3 h after surgery (P<0.001). A preventive EA before the end of operation provides an improved postoperative analgesia in comparison to pre-emptive EA with no side effects in patients undergoing major gynecologic surgery. Key words: Gynecologic surgery, postoperative pain, epidural administration, pre-emptive analgesia, bupivacaine, fentanyl.
Highlights
Peripheral and central nervous system sensitization results in postoperative pain hypersensitivity at the incision site and in surrounding tissues (Updike et al, 2003; Farouk, 2008)
The preventive group compared to the pre-emptive group had significantly decreased postoperative visual analog scale (VAS) in post anesthesia care unit (PACU) and up to 3 h after surgery (P
All patients received patient-controlled epidural analgesia (PCEA) with 0.125% of bupivacaine (1.25 mg/ml) and 5 μg/ml fentanyl delivered with a patient controlled analgesia (PCA) device (Abbott Pain Management Provider; Abbott Laboratories, North Chicago, IL) for 24 h postoperatively
Summary
Peripheral and central nervous system sensitization results in postoperative pain hypersensitivity at the incision site and in surrounding tissues (Updike et al, 2003; Farouk, 2008). "Pre-emptive" analgesia describes the concept of being able to reduce pain perception and overall analgesic needs by using agents to inhibit central nervous system sensitization before the application of painful stimuli (Akural et al, 2002; Hony et al, 2008; Atashkhoyi et al, 2011). "Preventive" analgesia includes any peri-operative analgesic regimen that is able to control pain-induced sensitization of the central nervous system (CNS), reducing both the development and the persistence of pathologic pain (Lavand’hmme et al, 2005). Superior analgesia after different operations was achieved with epidural injection of analgesics compared to other routes of analgesic administration (Zutshi et al, 2005; Klasen et al, 2005; Wu et al, 2000). The timing of epidural analgesic administration (pre-incision, during operation, at emergence from anesthesia or after operation) is another impact factor of the efficacy of analgesia. The timing of epidural analgesic administration (pre-incision, during operation, at emergence from anesthesia or after operation) is another impact factor of the efficacy of analgesia. Richards et al (1998) was unable to detect any significant difference in either of
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