title: Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy.
abstract: Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1 or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P < 0.01) but significantly lower pain scores during rest (P < 0.05) and mobilization (P < 0.01). More patients undergoing general anaesthesia received antiemetics (13 vs five; P < 0.05), but fewer received supplementary opioids on the ward (eight vs 16; P < 0.05). We conclude that opioid-free epidural-spinal anaesthesia for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine.
authors.affiliation: Department of Anaesthesiology, Copenhagen University Hospital, H:S Hvidovre Hospital, Denmark.
authors.forename: T
authors.initials: T
authors.lastname: Callesen
authors.forename: L
authors.initials: L
authors.lastname: Schouenborg
authors.forename: D
authors.initials: D
authors.lastname: Nielsen
authors.forename: H
authors.initials: H
authors.lastname: Guldager
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid; D000767:Anesthesia, Epidural; D000769:Anesthesia, Inhalation; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local; D002045:Bupivacaine; D003371:Cough / Q000517:prevention & control; D004809:Ephedrine; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009020:Morphine; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D004809:Ephedrine; D002045:Bupivacaine