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British Journal of Anaesthesia, Vol 82, Issue 6 881-885, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia

CLINICAL INVESTIGATIONS

Combined epidural--spinal opioid-free anaesthesia and analgesia for hysterectomy

T. Callesen, L. Schouenborg, D. Nielsen, H. Guldager and H. Kehlet
Departments of Anaesthesiology, Gynaecology and Obstetrics, and Surgical Gastroenterology, Copenhagen University Hospital, H:S Hvidovre Hospital, DK- 2650 Hvidovre, Denmark

Postoperative nausea and vomiting (PONV) are major problems after gynaecological surgery. We studied 40 patients undergoing total abdominal hysterectomy, allocated randomly to receive opioid-free epidural-spinal anaesthesia or general anaesthesia with continuous epidural bupivacaine 15 mg h-1 or continuous bupivacaine 10 mg h-1 with epidural morphine 0.2 mg h-1, respectively, for postoperative analgesia. Nausea, vomiting, pain and bowel function were scored on 4- point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P < 0.01) but significantly lower pain scores during rest (P < 0.05) and mobilization (P < 0.01). More patients undergoing general anaesthesia received antiemetics (13 vs five; P < 0.05), but fewer received supplementary opioids on the ward (eight vs 16; P < 0.05). We conclude that opioid- free epidural-spinal anaesthesia for hysterectomy caused less PONV, but with less effective analgesia compared with general anaesthesia with postoperative continuous epidural morphine and bupivacaine.
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R. G. Wheatley, S. A. Schug, and D. Watson
Safety and efficacy of postoperative epidural analgesia
Br. J. Anaesth., July 1, 2001; 87(1): 47 - 61.
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