Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy

In a double blind study we have investigated the effects ofepidural local anaesthesia (LA), when added to general anaesthesia(GA) and postoperative paracetamol and NSAID, on postoperativepain and gastrointestinal function in patients undergoing openhysterectomy. Sixty patients were randomized into three studygroups: GA, and postoperative paracetamol and NSAID (GA, n=20);GA, paracetamol, NSAID, intraoperative epidural lidocaine and24-h postoperative epidural saline (Saline, n=20); or GA, paracetamol,NSAID, intraoperative epidural lidocaine and 24-h postoperativeepidural bupivacaine (Bupi, n=20). Patients were observed for72 h postoperatively. Pain at rest, during cough, and mobilization,request for supplementary morphine, and time to first postoperativeflatus, was reduced in patients receiving 24-h postoperativeepidural anaesthesia, compared with the two other groups. However,these effects of epidural LA, were not sustained beyond theperiod of infusion, and no differences in PONV, time to firstpostoperative defecation, mobilization or time to dischargefrom hospital were observed between groups. A 24 h postoperativeepidural infusion with bupivacaine, when added to postoperativeparacetamol and NSAID, reduces pain and opioid requirements,but has only limited effects on gastrointestinal function andpatient recovery. Br J Anaesth 2001; 87: 577–83