Pain relief and functional status after vaginal hysterectomy: intrathecal versus general anesthesia.
OBJECTIVE
We tested the hypothesis that the use of subarachnoid block (SAB) for vaginal hysterectomy produces superior postoperative analgesia and improves functional status at 12 weeks postoperatively.


METHODS
In this randomized controlled trial 89 patients received either standardized general anesthesia vs SAB with bupivacaine, clonidine, and morphine. Postoperatively, patients in both groups received multimodal pain management. Primary outcomes included evaluation of pain and functional status (SF-36 Health Survey) over the 12 postoperative weeks.


RESULTS
Pain was well controlled throughout the study, as judged from the average pain numerical scale scores of < or = 3 in both groups, at all times studied. Intrathecal analgesia lessened pain and decreased the use of morphine both in the postanesthesia care unit (PACU) and over the first 12 hr after discharge from the PACU (P < 0.001). Although patients who received SAB had a lower frequency of postoperative nausea in the PACU than the patients in the general anesthesia group (P = 0.021), this effect was not extended beyond the PACU stay. Subarachnoid block did not affect the length of hospitalization. At the two-week follow-up 69% of patients in the SAB group and 48% patients in the general anesthesia group were pain free (P = 0.044). At all evaluation intervals patients' functional status was comparable between the SAB and general anesthesia group.


CONCLUSIONS
A significantly better immediate postoperative analgesia was present in the SAB group, and the duration was consistent with the expected action of intrathecally administered drugs. Two weeks after surgery a higher percentage of the patients in the SAB group reported no pain. However, SAB had no effect on either length of hospitalization or patients' postoperative functional status.
Sprung
Juraj
J
Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota 55905, USA. sprung.juraj@mayo.edu
Sanders
Malcolm S
MS
Warner
Mary Ellen
ME
Gebhart
John B
JB
Stanhope
C Robert
CR
Jankowski
Christopher J
CJ
Liedl
Lavonne
L
Schroeder
Darrell R
DR
Brown
Daniel R
DR
Warner
David O
DO
D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D003000:Clonidine / Q000008:administration & dosage; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000517:prevention & control*; D013346:Subarachnoid Space / Q000187:drug effects
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D003000:Clonidine; D002045:Bupivacaine