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British Journal of Anaesthesia, 2002, Vol. 88, No. 6 803-808
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Pre-emptive effect of epidural sufentanil in abdominal hysterectomy

E. I. Akural*,1, T. E. Salomäki1, A. H. Tekay2, A. H. Bloigu3 and S. M. Alahuhta1

1Department of Anaesthesiology, University of Oulu. 2Department of Obstetrics and Gynaecology, University of Oulu. 3National Public Health Institute, Oulu, Finland*Corresponding author: Department of Anaesthesiology, University Hospital of Oulu, PO Box 5000, FIN-90014, University of Oulu, Oulu, Finland

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 µg 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.

Br J Anaesth 2002; 88: 803–8


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