[Effects of preincisional epidural administration of lidocaine and fentanyl on postoperative pain management following hysterectomy].
OBJECTIVE
To compare the effect of preincisional administration different combination of epidural lidocaine and fentanyl on postoperative analgesia after hysterectomy.


METHODS
75 ASA I-II patients undergoing hysterectomy who were matched in age, weight, and duration of surgical procedure, were randomly allocated to one of the three treatment groups, 25 in each: group I receiving epidural saline as control, group II receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl 30 minutes before skin incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery, and group III receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl and 0.15 mg/ml of droperidol 30 min before incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery. Patient-controlled epidural analgesia (0.125% ropivacaine and 2 microg/ml fentanyl.) was given for postoperative pain relief in all groups (5 ml bolus followed by 3 ml/h infusion, PCA dose: 2 ml, lock out time: 10 min.). Postoperative pain intensity at rest and during movement was assessed on a visual analogue scale (VAS) by a blinded observer for 48 h after surgery. Analgesic requirements and side effects were compared among the three groups.


RESULTS
In the first 24 hours after surgery, the VAS score at rest reported by the patients in group I was 2.2 +/- 1.5, significantly higher than that in group II (1.4 +/- 0.8, P < 0.05,) and that in group III (1.1 +/- 1.1, P < 0.01), while the VAS score during coughing in group I was 3.0 +/- 1.1, higher than that in group II (2.1 +/- 0.8) and that in group III (1.5 + 1.3,P < 0.01 ). Analgesic requirements in the first 24 hours were 101 +/- 17 ml in group I, 82 +/-9 ml in group II, and 78 ml +/- 9 ml in group III, without significant difference among the groups. However, the analgesic requirement in the second 24 hours was 82 +/- 11 ml in group I, much more than that in group II (76 +/- 5 ml, P < 0.05) and in group III (73 ml +/- 2 ml, P < 0.01). The incidence of nausea, was significantly higher in Group I than in group III (P < 0.05). The incidence rates of pruritus and motor block were higher in group I too.


CONCLUSIONS
The preoperative administration of epidural lidocaine and small dose of fentanyl with droperidol, compared with saline administration, improves the postoperative pain management and reduces postoperative analgesic consumption and side effects.
Department of Anesthesiology, Peking University People's Hospital, Beijing, China.
Lan
L
Yao
Tianlong
T
Wang
Baxian
B
Yang
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D009043:Motor Activity / Q000187:drug effects; D009325:Nausea / Q000139:chemically induced; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011537:Pruritus / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008012:Lidocaine; D005283:Fentanyl