Abstract
Purpose
Thoracic epidural analgesia (TEA) is an established technique for postoperative pain relief after major abdominal surgery. However it is still under discussion whether pre-incisional TEA can reduce postoperative pain perception or postoperative analgesic consumption.
Methods
The present prospective, randomized, double-blind study was performed to investigate the effects of intra- and postoperative TEA vs only postoperative TEA using ropivacaine 0.375% in 30 women scheduled for major abdominal tumour surgery. Prior to induction of general anesthesia patients received an epidural bolus of 10 mL saline in Group I (GI) and 10 mL ropivacaine 0.375% in Group II (GII) followed by an infusion of 6 mL·hr−1 of the respective solution during surgery. Postoperatively all patients received an epidural infusion of 6 mL·hr−1 ropivacaine 0.375% during 24 hr followed by patient controlled epidural analgesia for the next 72 hr. Operative data, dynamic pain scores, consumption of local anesthetics and standardized supplemental analgesics were analyzed.
Results
No difference was seen between groups with respect to the amount of required postoperative local anesthetics and supplemental analgesics, pain scores and side effects during the first 96 hr following surgery except a reduction of intraoperative sufentanil consumption (GI: 143.2 ± 52.6vs GII: 73.3 ± 32.6μg,P < 0.001).
Conclusion
Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery.
Résumé
Objectif
L’analgésie péridurale thoracique (APT) est une technique reconnue pour l’analgésie suivant une opération abdominale majeure. Mais on se demande encore si l’administration d’APT avant l’incision peut réduire la perception de la douleur ou la consommation d’analgésique postopératoires.
Méthode
La présente étude prospective, randomisée et en double aveugle a été réalisée pour rechercher les effets de l’APT peropératoire et postopératoire vs l’APT postopératoire seulement à base de ropivacaïne à 0,375 % chez 30 patientes subissant une opération majeure pour tumeur abdominale. Avant l’induction de l’anesthésie générale, les patientes ont reçu un bolus péridural de 10 mL d’une solution saline dans le Groupe I (GI) et 10 mL de ropivacaïne à 0,375 % dans le Groupe II (GII), suivi d’une perfusion de 6 mL·h−1 de la solution respective pendant l’opération. Après l’opération, toutes les patientes ont reçu une perfusion péridurale de 6 mL·h−1 de ropivacaïne à 0,375 % pendant 24 h, suivie d’une analgésie péridurale autocontrôlée pour les 72 h suivantes. Les données opératoires, les scores de douleur dynamiques, la consommation d’anesthésiques locaux et d’analgésiques supplémentaires normalisés ont été analysés.
Résultats
Il n’y avait aucune différence intergroupe quant à la quantité d’anesthésiques locaux et supplémentaires postopératoires, aux scores de douleur et aux effets secondaires pendant les 96 premières heures postopératoires, sauf une réduction de la consommation de sufentanil peropératoire (GI : 143,2 ± 52,6 vs GII : 73,3 ± 32,6 μg, P < 0,001).
Conclusion
L’APT peropératoire utilisant de la ropivacaïne à 0,375% ne réduit pas significativement la quantité d’analgésique nécessaire après une opération majeure pour tumeur gynécologique abdominale.
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This study was supported by AstraZeneca, Germany and included payment of patient insurance and the fee of the local Ethics Committee. Results of this work have been presented at the German Congress of Anaesthesiology in Nuremberg, June 2001, at the Annual Meeting of the ASA, in New Orleans, October 2001.
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Burmeister, M.A., Gottschalk, A., Freitag, M. et al. Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery. Can J Anesth 50, 568–573 (2003). https://doi.org/10.1007/BF03018642
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DOI: https://doi.org/10.1007/BF03018642