Pre-emptive effect of epidural sufentanil in abdominal hysterectomy.

Autor:	Akural EI; Department of Anaesthesiology, University Hospital of Oulu, PO Box 5000, FIN-90014, University of Oulu, Oulu, Finland., Salomäki TE, Tekay AH, Bloigu AH, Alahuhta SM
Jazyk:	angličtina
Zdroj:	British journal of anaesthesia [Br J Anaesth] 2002 Jun; Vol. 88 (6), pp. 803-8.
DOI:	10.1093/bja/88.6.803
Abstrakt:	Background: Experimental studies suggest pre-emptive administration of analgesics is effective but clinical evidence is less convincing. Methods: Forty-one patients undergoing abdominal hysterectomy were allocated randomly in a double-blind fashion to receive sufentanil 50 micrograms via a lumbar epidural catheter before or at the end of surgery. Results: Sufentanil consumption from a patient-controlled epidural analgesia (PCEA) system and numerical pain scores at rest and during movement over the initial 72 h were similar in the two groups. When the study period was divided into five time intervals, sufentanil consumption in the pre-emptive group was significantly less than in the control group between 8 and 16 h after surgery (P = 0.04). Furthermore, the number of failed bolus attempts from the PCEA device was significantly lower and patient satisfaction was significantly better in the pre-emptive group during the 72 h of PCEA treatment (P < 0.05). In addition, the median decrease in ACTH and cortisol on the first postoperative morning relative to baseline values was greater in the pre-emptive group than in the control group (P < 0.05). In subjects who had a Pfannenstiel incision, touch and pain sensitivity in the wound area were less in the pre-emptive group over the first 4 postoperative days (P < 0.05). Conclusions: We conclude that pre-emptive analgesia with epidural sufentanil was associated with a short-term sufentanil-sparing effect, and could have reduced stress hormone responses and wound sensitization after abdominal hysterectomy.
Databáze:	MEDLINE
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