Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery.
BACKGROUND
The concept of pre-emptive analgesia remains controversial. This prospective, randomized, and double-blind study compared epidural administration of ropivacaine 2 mg ml(-1), sufentanil 0.5 microg ml(-1), clonidine 3 microg ml(-1), and S(+)-ketamine 0.25 mg ml(-1) (study solution) given before incision with the same combination started at the end of the operation.


METHODS
After testing the stability of the solution using high performance liquid chromatography (HPLC) and examining 12 patients for possible side-effects in comparison with the epidural infusion of ropivacaine 2 mg ml(-1) and sufentanil 0.5 microg ml(-1), 30 patients undergoing major pancreatic surgery were recruited into the study. Before induction of anaesthesia, an epidural catheter was inserted (TH6-8). Patients in Group 1 received a bolus of 8 ml followed by a continuous infusion (8 ml h(-1)) of the study solution before induction of anaesthesia. In Group 2, patients received the same volume of saline before operation, the study solution was started at the end of surgery. After operation, the infusion was maintained for at least 96 h using a patient-controlled epidural analgesia (PCEA) pump in both groups. Patients were evaluated up to the seventh postoperative day for pain and side-effects.


RESULTS
Visual analogue scale (VAS) values at rest were as follows: G1 vs G2: 24 h, 19 (sd 23) vs 6 (13); 48 h, 4 (10) vs 11 (21); and 72 h, 12 (22) vs 13 (21). VAS values during coughing and mobilization were also comparable. Total volume of epidural infusion was 904 (114) ml in G1 vs 892 (154) ml in G2. The incidence of side-effects (nausea, vomiting, and motor block) was low and not different between the groups.


CONCLUSIONS
Pre-incisional epidural analgesic infusion did not provide pre-emptive analgesia compared with administration started at the end of surgery, but both groups had low pain scores.
Gottschalk
A
A
Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Knappschaftskrankenhaus Bochum Langendreer, University Hospital Bochum, In der Schornau 23-25, 44892 Bochum, Germany. gottschalk.andre@gmx.de
Freitag
M
M
Steinacker
E
E
Kreissl
S
S
Rempf
C
C
Staude
H-J
HJ
Strate
T
T
Standl
T
T
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D003000:Clonidine / Q000008:administration & dosage; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004355:Drug Stability; D005260:Female; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D010179:Pancreas / Q000601:surgery*; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000008:administration & dosage
D000577:Amides; D004338:Drug Combinations; D007649:Ketamine; D000077212:Ropivacaine; D017409:Sufentanil; D003000:Clonidine