Pre-emptive effect of epidural sufentanil in abdominal hysterectomy.
BACKGROUND
Experimental studies suggest pre-emptive administration of analgesics is effective but clinical evidence is less convincing.


METHODS
Forty-one patients undergoing abdominal hysterectomy were allocated randomly in a double-blind fashion to receive sufentanil 50 micrograms via a lumbar epidural catheter before or at the end of surgery.


RESULTS
Sufentanil consumption from a patient-controlled epidural analgesia (PCEA) system and numerical pain scores at rest and during movement over the initial 72 h were similar in the two groups. When the study period was divided into five time intervals, sufentanil consumption in the pre-emptive group was significantly less than in the control group between 8 and 16 h after surgery (P = 0.04). Furthermore, the number of failed bolus attempts from the PCEA device was significantly lower and patient satisfaction was significantly better in the pre-emptive group during the 72 h of PCEA treatment (P < 0.05). In addition, the median decrease in ACTH and cortisol on the first postoperative morning relative to baseline values was greater in the pre-emptive group than in the control group (P < 0.05). In subjects who had a Pfannenstiel incision, touch and pain sensitivity in the wound area were less in the pre-emptive group over the first 4 postoperative days (P < 0.05).


CONCLUSIONS
We conclude that pre-emptive analgesia with epidural sufentanil was associated with a short-term sufentanil-sparing effect, and could have reduced stress hormone responses and wound sensitization after abdominal hysterectomy.
Akural
E I
EI
Department of Anaesthesiology, University Hospital of Oulu, PO Box 5000, FIN-90014, University of Oulu, Oulu, Finland.
Salomäki
T E
TE
Tekay
A H
AH
Bloigu
A H
AH
Alahuhta
S M
SM
D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000097:blood; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007044:Hysterectomy; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011229:Preanesthetic Medication; D017409:Sufentanil / Q000008:administration & dosage* / Q000097:blood
D000701:Analgesics, Opioid; D000324:Adrenocorticotropic Hormone; D017409:Sufentanil; D006854:Hydrocortisone