Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial.
BACKGROUND
Although pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia.


METHODS
One hundred patients undergoing abdominal hysterectomy were randomly divided into four groups (Trial registration: ChiCTR-IPR-15005848). Group P1 was given intravenous flurbiprofen and epidural fentanyl + ketamine before surgery; Group P2 received intravenous flurbiprofen before surgery and epidural fentanyl + ketamine after surgery; Group P3 was given epidural fentanyl + ketamine before surgery and intravenous flurbiprofen after surgery; Patients in Group C received normal saline treatment.


RESULTS
Compared with control group, the first time to request additional analgesics after surgery were significantly later (P < 0.05), 24 h dosage of analgesia were significantly less (P < 0.05), VAS score at all time periods after surgery were significantly lower (P < 0.05) in Group P1, P2, or P3. At 12 h or 24 h after surgery, VAS score in Group P1 was significantly lower than that in group P2 or P3 (P < 0.05, P < 0.05). No significant adverse effects were found among the groups (P > 0.05). At 1 or 2 days after surgery, the levels of cortisol, glucose, and IL-6, TNF-α in group P1, P2, and P3 were significantly lower than those in group C (P < 0.05); while, the levels in group P2, P3 were significantly lower than those in group P1 (P < 0.05).


CONCLUSIONS
Multimodal pre-emptive analgesia could significantly lower VAS score, inhibit stress response, and reduce inflammatory response in patients undergoing transabdominal hysterectomy, which can be a rational strategy for pain control in future.


BACKGROUND
ChiCTR-IPR-15005848 on January 17, 2015.
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. jywly200901@163.com.
Jian-qing
JQ
Chen
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. wuzhenvip1234@126.com.
Zhen
Z
Wu
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. laiyouwen11@126.com.
Lai-you
LY
Wen
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. JianzhongMiao12@163.com.
Jian-zhong
JZ
Miao
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. yongminghu23@163.com.
Yong-ming
YM
Hu
Department of Anesthesiology, The Affiliated Jiangyin Hospital of Nantong University, 163 Shoushan Road, Jiangyin, Jiangsu Province, China. ruipingxue987@126.com.
Ruiping
R
Xue
D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D005480:Flurbiprofen / Q000627:therapeutic use; D006801:Humans; D007044:Hysterectomy; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D007649:Ketamine / Q000627:therapeutic use; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D012965:Sodium Chloride / Q000008:administration & dosage; D013312:Stress, Physiological / Q000187:drug effects
D000700:Analgesics; D000701:Analgesics, Opioid; D012965:Sodium Chloride; D005480:Flurbiprofen; D007649:Ketamine; D005283:Fentanyl