Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery
| dc.contributor.author | Katz, Joel | |
| dc.contributor.author | Clairoux, Michel | |
| dc.contributor.author | Kavanagh, Brian P. | |
| dc.contributor.author | Roger, Sandra | |
| dc.contributor.author | Nierenberg, Hilary | |
| dc.contributor.author | Redahan, Cormac | |
| dc.contributor.author | Sandler, Alan N. | |
| dc.date.accessioned | 2011-05-18T18:27:43Z | |
| dc.date.available | 2011-05-18T18:27:43Z | |
| dc.date.issued | 1994 | |
| dc.description.abstract | 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-two patients (ASA class I-III) scheduled for lower abdominal surgery were randomly assigned to 1 of 2 groups of equal size and prospectively studied using a double-blind, placebo-controlled crossover design. Epidural catheters were placed in the T12-L1 or L1-L2 interspaces pre-operatively, the position of the catheter was confirmed with 3% chloroprocaine with epinephrine 1:200,000, and sensory testing was carried out until levels had receded to below T12. Group 1 received 15 ml of 0.5% 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 ml of 0.5% epidural bupivacaine 30 min after incision. General anaesthesia was induced with thiopental (4–6 mg/kg) and maintained with N2O/O2 and isoflurane. Paralysis was achieved with pancuronium (0.1 mg/kg). Opioids were not used as pre-medication or during surgery. Postoperative analgesia consisted of patient-controlled (PCA) intravenous morphine. Visual analogue pain scores (VAS) (at rest and after standardized mobilization) did not differ significantly between the 2 groups but McGill Pain Questionnaire (MPQ) pain ratings were significantly lower in group 1 at the 24 and 72 h assessments. Group 1 used significantly less morphine than did group 2 between 12 and 24 h after surgery. Cumulative PCA morphine consumption in group 1 (55.2 ± 4.7 mg) was significantly lower than in group 2 (71.7 ± 6.1 mg) 24 h and 48 h (group 1: 86.8 ± 6.3 mg vs. group 2: 108.9 ± 9.8 mg) after surgery, but not at the 72 h assessment. Reduction in morphine dose at 24, 48 and 72 h amounted to 30%, 25% and 22%, respectively. 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. | en |
| dc.identifier.citation | Pain, 59(3), 395-403. (1994) | |
| dc.identifier.uri | http://hdl.handle.net/10315/7936 | |
| dc.language.iso | en | en |
| dc.publisher | Elsevier | en |
| dc.rights.article | http://www.painjournalonline.com/article/0304-3959(94)90026-4/abstract | |
| dc.rights.journal | http://www.elsevier.com/wps/find/journaldescription.cws_home/506083/description#description | en |
| dc.rights.publisher | http://www.elsevier.com | en |
| dc.subject | Inflammation | en |
| dc.subject | abdominal; Pre-emptive analgesia | en |
| dc.subject | Morphine; Surgery | en |
| dc.subject | Patient-controlled analgesia | en |
| dc.subject | Epidural bupivacaine | en |
| dc.title | Pre-emptive lumbar epidural anaesthesia reduces postoperative pain and patient-controlled morphine consumption after lower abdominal surgery | |
| dc.type | Article | en |