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Canadian Journal of Anesthesia 53:690-700 (2006)
© Canadian Anesthesiologists' Society, 2006
Regional Anesthesia and Pain

Pain relief and functional status after vaginal hysterectomy: intrathecal versus general anesthesia

[Le contrôle de la douleur et l’état fonctionnel après l’hystérectomie vaginale : l’anesthésie intrathécale versus l’anesthésie générale]

Juraj Sprung, MD, PhD, Malcolm S. Sanders, MD, Mary Ellen Warner, MD, John B. Gebhart, MD, C. Robert Stanhope, MD, Christopher J. Jankowski, MD, Lavonne Liedl, RT, Darrell R. Schroeder, MS, Daniel R. Brown, MD, PhD and David O. Warner, MD

From the Department of Anesthesiology, Mayo Clinic College of Medicine, Anesthesia Clinical Research Unit, Mayo Clinic, Rochester, Minnesota, USA.

Address correspondence to: Dr. Juraj Sprung, Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA. Phone: 507-255-3298; Fax: 507-255-6463; E-mail: sprung.juraj{at}mayo.edu

Purpose: 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 ≤ 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.






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Copyright © 2006 by the Canadian Anesthesiologists' Society.