title: [Appropriate duration of postoperative pain relief by continuous epidural infusion in patients receiving hysterectomy or ovarian tumor resection: comparison of three methods].
abstract: We evaluated effects of continuous epidural infusion on postoperative pain, and frequency of its side effects. Patients who had undergone elective gynecological operations were randomly allocated into three groups by difference in duration of indwelling of epidural catheters: patients receiving epidural block only during operations (group M); patients receiving continuous epidural infusion for 2 postoperative days (group B 2); patients receiving continuous epidural infusion for 4 postoperative days (group B 4). In group M, morphine 3 mg and 1 or 2% lidocaine 5-7 ml were given before the start of operation, and epidural catheter was removed after the end of operations. In group B 2 and B 4, morphine 2 mg and 1 or 2% lidocaine 5-7 ml were given before the start of operation, and morphine 8 mg in 50 ml of 0.25% bupivacaine was continuously infused at a rate of 0.5-1 ml.hr-1. We evaluated visual analogue scale (VAS) at rest and moving, and verbal descriptor pain score. Frequencies of supplementary analgesics, vomiting and nausea, residual urine volume after removal of bladder catheter, and timing to initiation of bowel movement after operation were also recorded. VAS at rest was significantly higher in group M than in groups B 2 and B 4 for 2 postoperative days, but no significant difference was seen between the three groups for three postoperative days. VAS at moving did not differ between the 3 groups. Verbal descriptor pain score was significantly higher in group M than in groups B 2 and B 4 for 3 postoperative days, but it was not different between groups B 2 and B 4. In group B 2, patients complained increased abdominal pain after removing catheters. Frequencies of supplementary analgesics were 3.7, 0.6 and 0.4 times in group M, B 2, B 4, respectively. Times to initiation of bowel movement after operation were 39.8, 46.5 and 61.7 hrs in group M, B 2, and B 4, respectively, and most patients in group B 4 felt uncomfortable. These results suggest that continuous epidural analgesia for 2 postoperative days is appropriate, but the duration should be determined according to patient's conditions and complications.
authors.affiliation: Department of Anesthesiology, Kumamoto University School of Medicine.
authors.forename: N
authors.initials: N
authors.lastname: Sawada
authors.forename: K
authors.initials: K
authors.lastname: Higashi
authors.forename: F
authors.initials: F
authors.lastname: Yanagi
authors.forename: H
authors.initials: H
authors.lastname: Mitsuhata
authors.forename: T
authors.initials: T
authors.lastname: Akasaka
authors.forename: M
authors.initials: M
authors.lastname: Nishi
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D010052:Ovariectomy; D010149:Postoperative Pain / Q000188:drug therapy*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine; D002045:Bupivacaine