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Pre- and intraoperative epidural ropivacaine have no early preemptive analgesic effect in major gynecological tumour surgery

[L’administration préopératoire et peropératoire de ropivacaïne n’a pas d’effet analgésique préventif précoce pour l’opération majeure d’une tumeur gynécologique]

From the Department of Anesthesia, University Hospital Hamburg-Eppendorf, Hamburg, Germany.

Address correspondence to: Dr. Marc A. Burmeister, Department of Anesthesia, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. Phone: +49-40-42803-2415/4525; Fax: +49-40-42803-4963; E-mail: burmeister{at}uke.uni-hamburg.de

Purpose: 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•hr^-1 of the respective solution during surgery. Postoperatively all patients received an epidural infusion of 6 mL•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 µg, P < 0.001).

Conclusion: Intraoperative TEA with ropivacaine 0.375% did not significantly reduce the amount of analgesics required after major abdominal gynecological tumour surgery.

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