Preventive analgesia is associated with reduced pain disability 3 weeks but not 6 months after major gynecologic surgery by laparotomy.
BACKGROUND
Most studies of preemptive or preventive analgesia restrict outcomes to pain and analgesic consumption in the acute postoperative period. The potential longer-term effects on these and other domains of functioning have received little empirical attention. The purpose of this study was to follow up patients who had received general anesthesia plus epidural fentanyl and lidocaine before (group 1) or after (group 2) incision or general anesthesia plus a sham epidural (group 3).


METHODS
Patients were contacted approximately 3 weeks and 6 months after surgery. A follow-up pain questionnaire and the McGill Pain Questionnaire were administered by telephone. The Mental Health Inventory and Pain Disability Index were mailed to patients, completed, and mailed back.


RESULTS
One hundred thirty-one of the 141 patients (93%) were reached 3 weeks after surgery (n = 41, n = 48, and n = 42 in groups 1, 2, and 3, respectively), and 109 (77%) were reached at 6 months (n = 35, n = 37, and n = 37 in groups 1, 2, and 3, respectively). Multivariate analysis of covariance indicated that that even after controlling for age and presence or absence of preoperative pain, Pain Disability Index scores (mean +/- SD) at the first follow-up were significantly lower in group 1 (17.3 +/-12.8) and group 2 (18.1 +/-17.0) compared with group 3 (26.3 +/- 18.3). McGill Pain Questionnaire and Mental Health Inventory scores did not differ significantly among the groups. There were no significant differences at the 6-month follow-up.


CONCLUSIONS
The short-term beneficial effects of preventive epidural analgesia translated into less pain disability 3 weeks after surgery. Progress in understanding the processes involved in postsurgical recovery and the risk factors for chronic postsurgical pain would be aided by baseline and postsurgical measures of relevant psychological, emotional, and physical variables.
Katz
Joel
J
Department of Psychology and School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada. jkatxz@uhnres.utoronto.ca
Cohen
Lorenzo
L
D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect / Q000187:drug effects; D000698:Analgesia; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000627:therapeutic use; D004185:Disability Evaluation; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D006930:Hyperalgesia / Q000139:chemically induced / Q000503:physiopathology; D007813:Laparotomy; D008012:Lidocaine / Q000627:therapeutic use; D008016:Life Change Events; D008603:Mental Health; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine; D005283:Fentanyl