title: Preemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial.
abstract: BACKGROUND
  Preemptive analgesia can decrease the sensitization of the central nervous system that would ordinarily amplify subsequent nociceptive input, but a clear demonstration of its clinical efficacy is necessary for it to become a routine component of acute pain therapy.
  
  
  OBJECTIVE
  To determine the impact of preemptive epidural analgesia on postoperative pain and other clinically important outcome variables after radical retropubic prostatectomy.
  
  
  METHODS
  A block randomized double-blind clinical trial lasting 20 months at a single academic medical center.
  
  
  METHODS
  A total of 100 generally healthy and neurologically intact patients scheduled for radical retropubic prostatectomy for the treatment of prostate cancer in whom an epidural catheter for treating postoperative pain was to be placed prior to the induction of general anesthesia.
  
  
  METHODS
  Epidural bupivacaine, epidural fentanyl, or no epidural drug was administered prior to induction of anesthesia and throughout the entire operation, followed by aggressive postoperative epidural analgesia for all patients.
  
  
  METHODS
  Daily pain scores during hospitalization and pain scores obtained 3.5, 5.5, and 9.5 weeks after hospital discharge.
  
  
  RESULTS
  The patients who received epidural fentanyl or bupivacaine prior to surgical incision (preemptive analgesia) experienced 33% less pain while hospitalized (P=.007). Pain scores in those receiving preemptive analgesia were significantly lower at 9.5 weeks (P=.02), but were not significantly different at 3.5 or 5.5 weeks. At 9.5 weeks, 32 (86%) of 37 patients receiving preemptive analgesia were pain-free compared with 9 (47%) of 19 control patients (P=.004). Patients receiving preemptive analgesia were more active 3.5 weeks after surgery (P=.01), but not at 5.5 or 9.5 weeks.
  
  
  CONCLUSIONS
  Even in the presence of aggressive postoperative pain management, preemptive epidural analgesia significantly decreases postoperative pain during hospitalization and long after discharge, and is associated with increased activity levels after discharge.
authors.affiliation: Department of Anesthesia, School of Medicine, University of Pennsylvania, Philadelphia 19104, USA. ag@network3.entropy.upenn.edu
authors.forename: A
authors.initials: A
authors.lastname: Gottschalk
authors.forename: D S
authors.initials: DS
authors.lastname: Smith
authors.forename: D R
authors.initials: DR
authors.lastname: Jobes
authors.forename: S K
authors.initials: SK
authors.lastname: Kennedy
authors.forename: S E
authors.initials: SE
authors.lastname: Lally
authors.forename: V E
authors.initials: VE
authors.lastname: Noble
authors.forename: K F
authors.initials: KF
authors.lastname: Grugan
authors.forename: H A
authors.initials: HA
authors.lastname: Seifert
authors.forename: A
authors.initials: A
authors.lastname: Cheung
authors.forename: S B
authors.initials: SB
authors.lastname: Malkowicz
authors.forename: B B
authors.initials: BB
authors.lastname: Gutsche
authors.forename: A J
authors.initials: AJ
authors.lastname: Wein
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000700:Analgesics; D000704:Analysis of Variance; D000768:Anesthesia, General; D002045:Bupivacaine; D004311:Double-Blind Method; D005283:Fentanyl; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011468:Prostatectomy; D018709:Statistics, Nonparametric; D013997:Time Factors
chemical_list: D000700:Analgesics; D005283:Fentanyl; D002045:Bupivacaine