title: Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery.
abstract: OBJECTIVE
  Thoracic epidural analgesia (TEA) is an established technique for postoperative pain relief after major abdominal surgery. However it is still under discussion whether pre-incisional TEA can reduce postoperative pain perception or postoperative analgesic consumption.
  
  
  METHODS
  The present prospective, randomized, double-blind study was performed to investigate the effects of intra- and postoperative TEA vs only postoperative TEA using ropivacaine 0.375% in 30 women scheduled for major abdominal tumour surgery. Prior to induction of general anesthesia patients received an epidural bolus of 10 mL saline in Group I (GI) and 10 mL ropivacaine 0.375% in Group II (GII) followed by an infusion of 6 mL x hr(-1) of the respective solution during surgery. Postoperatively all patients received an epidural infusion of 6 mL x hr(-1) ropivacaine 0.375% during 24 hr followed by patient controlled epidural analgesia for the next 72 hr. Operative data, dynamic pain scores, consumption of local anesthetics and standardized supplemental analgesics were analyzed.
  
  
  RESULTS
  No difference was seen between groups with respect to the amount of required postoperative local anesthetics and supplemental analgesics, pain scores and side effects during the first 96 hr following surgery except a reduction of intraoperative sufentanil consumption (GI: 143.2 +/- 52.6 vs GII: 73.3 +/- 32.6 microg, P < 0.001).
  
  
  CONCLUSIONS
  Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery.
authors.affiliation: Department of Anesthesia, University Hospital Hamburg-Eppendorf, Hamburg, Germany. burmeister@uke.uni-hamburg.de
authors.forename: Marc A
authors.initials: MA
authors.lastname: Burmeister
authors.forename: André
authors.initials: A
authors.lastname: Gottschalk
authors.forename: Marc
authors.initials: M
authors.lastname: Freitag
authors.forename: Ernst P
authors.initials: EP
authors.lastname: Horn
authors.forename: Corinna
authors.initials: C
authors.lastname: Böhme
authors.forename: Cornelia
authors.initials: C
authors.lastname: Becker
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Standl
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D015360:Analgesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005833:Genital Neoplasms, Female / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine