Epidural verapamil reduces analgesic consumption after lower abdominal surgery.
In this double-blind study, we administered lumbar epidural bupivacaine or bupivacaine plus verapamil to investigate the possible role of the calcium channel blocker, verapamil, in postoperative pain. One hundred patients (ASA physical class I or II) scheduled for lower abdominal surgery were randomly assigned to one of four groups. Group 1 received 10 mL of 0.5% epidural bupivacaine injected 15 min before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 2 received 10 mL of epidural normal saline injected before incision, followed by 10 mL of 0.5% epidural bupivacaine 30 min after incision. Group 3 received 10 mL of 0.5% epidural bupivacaine plus 5 mg of verapamil injected before incision, followed by 10 mL of epidural normal saline 30 min after incision. Group 4 received the same drugs as Group 3, in the reverse order. Pain and mood numeric rating scores, sedation scores, Prince Henry scores, patient-controlled cumulative postoperative analgesic consumption, and the incidence of side effects were assessed 2, 6, 12, 24, and 48 h after the operation in each group. Cumulative postoperative analgesic consumption in Groups 3 and 4 was significantly lower (P < 0.05) than that in Groups 1 and 2 24 and 48 h after surgery. There were no differences in the pain, mood, and sedation scores and the incidence of side effects among the four groups. We conclude that epidural verapamil decreases postoperative pain, possibly by interfering with normal sensory processing and by preventing the establishment of central sensitization.


CONCLUSIONS
Calcium plays an important role in pain physiology at the spinal cord level. We examined the effect of bupivacaine plus verapamil (calcium channel blocker) and of bupivacaine alone. We demonstrated that the combination, administered epidurally, resulted in less postoperative analgesic consumption than bupivacaine alone.
Choe
H
H
Department of Anesthesiology, Chonbuk National University Medical School, Chonju, Republic of Korea.
Kim
J S
JS
Ko
S H
SH
Kim
D C
DC
Han
Y J
YJ
Song
H S
HS
D000005:Abdomen / Q000601:surgery*; D000328:Adult; D000339:Affect / Q000187:drug effects; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002121:Calcium Channel Blockers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D003243:Consciousness / Q000187:drug effects; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007268:Injections, Epidural; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010149:Postoperative Pain / Q000503:physiopathology / Q000517:prevention & control*; D011292:Premedication; D012677:Sensation / Q000187:drug effects; D012965:Sodium Chloride; D013116:Spinal Cord / Q000187:drug effects / Q000503:physiopathology; D014700:Verapamil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002121:Calcium Channel Blockers; D012965:Sodium Chloride; D009020:Morphine; D014700:Verapamil; D002045:Bupivacaine