Is epidural preemptive analgesia effective in lower abdominal surgery?

Abstract

In this study, we aimed to investigate the pre-emptive analgesic efficacy of epidural application of fentanly-bupivacaine combination. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. An epidural catheter was inserted to all patients through L 2-3 or L 3-4 space before general anesthesia induction. 2 ?g/kg fentanyl in 0.25% bupivacaine in 10 ml serum saline was applied to the preemptive analgesia group (Group P) 20 minutes before the incision, and to the post-incisional analgesia group (Group E) 20 minutes after the incision, whereas control group received 10 ml serum saline 20 minutes before the incision through the epidural catheter. Pain scores were assessed with 100 mm Visual Analogue Scale (VAS) and four point Verbal Rating Scale (VRS) at 1., 2., 4., 6., 12., 24., 48. hours postoperatively. First analgesic requirement time and total analgesic consumption for 48 hours were also recorded. The VAS and VRS values in the postoperative 48 hours were significantly lower in Group P compared with the other groups (p<0.05). First analgesic requirement time was also significantly prolonged in Group P (p<0.001). Total analgesic consumption in Group P was significantly lower than the other two groups (p<0.05). As a result we observed that preemptive administration of epidural fentanyl-bupivacaine combination reduces the postoperative pain and analgesic consumption in lower abdominal surgery.