[Effects of preincisional epidural administration of lidocaine and fentanyl on postoperative pain management following hysterectomy]

Abstract

Objective: To compare the effect of preincisional administration different combination of epidural lidocaine and fentanyl on postoperative analgesia after hysterectomy.

Methods: 75 ASA I-II patients undergoing hysterectomy who were matched in age, weight, and duration of surgical procedure, were randomly allocated to one of the three treatment groups, 25 in each: group I receiving epidural saline as control, group II receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl 30 minutes before skin incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery, and group III receiving epidural 2% lidocaine 10 ml combined with 2.5 microg/ml of fentanyl and 0.15 mg/ml of droperidol 30 min before incision followed by 0.125% ropivacaine and 2 microg/ml fentanyl infusion at 9ml/h to the end of surgery. Patient-controlled epidural analgesia (0.125% ropivacaine and 2 microg/ml fentanyl.) was given for postoperative pain relief in all groups (5 ml bolus followed by 3 ml/h infusion, PCA dose: 2 ml, lock out time: 10 min.). Postoperative pain intensity at rest and during movement was assessed on a visual analogue scale (VAS) by a blinded observer for 48 h after surgery. Analgesic requirements and side effects were compared among the three groups.

Results: In the first 24 hours after surgery, the VAS score at rest reported by the patients in group I was 2.2 +/- 1.5, significantly higher than that in group II (1.4 +/- 0.8, P < 0.05,) and that in group III (1.1 +/- 1.1, P < 0.01), while the VAS score during coughing in group I was 3.0 +/- 1.1, higher than that in group II (2.1 +/- 0.8) and that in group III (1.5 + 1.3,P < 0.01 ). Analgesic requirements in the first 24 hours were 101 +/- 17 ml in group I, 82 +/-9 ml in group II, and 78 ml +/- 9 ml in group III, without significant difference among the groups. However, the analgesic requirement in the second 24 hours was 82 +/- 11 ml in group I, much more than that in group II (76 +/- 5 ml, P < 0.05) and in group III (73 ml +/- 2 ml, P < 0.01). The incidence of nausea, was significantly higher in Group I than in group III (P < 0.05). The incidence rates of pruritus and motor block were higher in group I too.

Conclusion: The preoperative administration of epidural lidocaine and small dose of fentanyl with droperidol, compared with saline administration, improves the postoperative pain management and reduces postoperative analgesic consumption and side effects.