The Comparison of Preemptive Analgesic Effectiveness of Epidural and Intravenous Fentanil

Abstract

In this study, we aimed to compare the preemptive analgesic effect of fentanyl, which is used by intravenous or epidural route, in total abdominal hysterectomy (TAH). Fifty-four ASA I-II patients who admitted for total abdominal hysterectomy were included to this study and patients were randomly separated into three groups. All patients were given standard general anesthesia. General anesthesia alone was given in control group (Group K). In epidural analgesia group (Group E), epidural catheter was inserted preoperatively through L2-3 interspace and 4 ?g kg-I fentanyl in 10 mL0.9 % NaCl was administered 30 min. before incision. In intravenous analgesia group (Group I), fentanyl 4 ?g kg-1 was administered intravenously 5 min. before skin incision. Pain scores were assessed with visual analogue scale (VAS) at 1st, 2nd, 4th, 6th, 12th and 24th hours postoperatively. First analgesic requirement time and total analgesic consumption were also recorded. Surgical stress response was evaluated with the blood glucose and plasma cortisol levels of patients whom were obtained before the incision and postoperative 4th hour. Compared to the other two groups, we observed that remarkable lower VAS pain scores and total analgesic consumption was provided in Group E (p<0.05). First analgesic requirement time was also significantly prolonged in Group E (p<0.05). The blood glucose and plasma cortisol levels at 4th hour postoperatively were significantly lower in Group E when compared to the other two groups (p<0.05). As a result we suggested that preemptive epidural fentanyl administration was more effective than preemptive intravenous fentanyl in postoperative acute pain and surgical stress response control at total abdominal hysterectomy.