The effects of postoperative continuous epidural analgesia after laparoscopy-assisted distal gastrectomy

BACKGROUND: This study was conducted to evaluate the effects of continuous epidural analgesia on the postoperative pain and the early recovery after laparoscopy-assisted gastrectomy (LAG). METHODS: A total of 66 patients undergoing elective LAG were investigated for postoperative pain score and other variables retrospectively. RESULTS: Forty-four patients who had received epidural analgesia (E group) showed significantly lower pain scores for 2, 12 and 48 hours after surgery, compared with 22 patients who had received analgesics intramuscularly or transrectally (C group). The patients in the E group needed significantly less supplemental analgesics than those in C group for 2 and 12 hours after the operation. The early recovery and the incidence of postoperative complications were not significantly different between the two groups. CONCLUSIONS: These results show that postoperative continuous epidural analgesia is effective for postoperative pain relief in patients after laparoscopy-assisted gastrectomy.     

Significance of patient-controlled analgesia in combination with continuous epidural block for patients who underwent posterior lumbar surgery

The purpose of the study was to evaluate the efficiency of patient-controlled analgesia (PCA) combined with continuous epidural block in patients who underwent lumbar spine surgery. In group 1 (postoperative PCA group), 23 patients were administered postoperative continuous epidural block in combination with analgesics, which was self-regulated by the patient using a device. In contrast, the 22 patients in group 2 (control group) received suppositories or intramuscular injections of analgesics on request. The following factors were compared between the two groups: pain relief according to the visual analog scale for pain assessment, the frequency of administration of analgesics, and side effects of the postoperative analgesia. The patients in group 1 had more satisfactory relief of pain according to the visual analog scale for pain assessment and needed suppositories and intramuscular injection of analgesics less frequently on the 1st, 2nd, and 3rd postoperative day. The time spent by nurses on pain management in group 1 was less than that in group 2. No patient had any serious complications in either group. In conclusion, the present patient-controlled method combined with postoperative continuous epidural block could decrease the intensity of postoperative pain and the amount of time spent by nurses on the administration of postoperative analgesics after lumbar spine surgery. Received: 17 July 1997 Revised: 30 September 1997 Accepted: 14 October 1997     

Epidural anesthesia during upper abdominal surgery provides better postoperative analgesia

Since repeated noxious stimuli may sensitize neuropathic pain receptors of the spinal cord, we tested the hypothesis that the appropriate blockade of surgical stimuli with epidural anesthesia during upper abdominal surgery would be beneficial for postoperative analgesia. Thirty-six adult patients undergoing either elective gastrectomy or open cholecystectomy were randomly allocated to receive either inhalational general anesthesia alone (group G) or epidural anesthesia along with light general anesthesia (group E) throughout the surgery. Postoperative pain management consisted of patient-controlled analgesia (PCA) with bupivacaine accompanied by the continuous infusion of buprenorphine. To assess postoperative pain, a visual analogue scale (VAS) was employed at 2, 24, and 48 h postoperatively. While there was no significant difference in the bupivacaine dose, more patients undergoing gastrectomy in group G required supplemental analgesics than those in group E, and the VAS scores in group E demonstrated significantly better postoperative analgesia compared to group G after both types of surgery. Thus, an appropriate epidural blockade during upper abdominal surgery likely provides better postoperative pain relief.     

Postoperative nausea and vomiting caused by epidural infusion following gynecological laparoscopic surgery: fentanyl and ropivacaine versus ropivacaine alone

BACKGROUND:Patients who undergo gynecological laparoscopic surgery often begin to eat and ambulate soon after surgery. However, postoperative nausea and vomiting (PONV) can postpone recovery. METHODS: We prospectively investigated the incidence of PONV, along with oral intake and ambulation in patients who received an epidural infusion following gynecological laparoscopic surgery with combined epidural and general anesthesia. Forty patients were randomly and equally divided into 2 groups: group R, who received patient-controlled epidural analgesia (PCEA) with 0.2% ropivacaine, and group FR, who received a continuous epidural infusion of 0.2% ropivacaine with fentanyl (CEA). PONV and pain were scored during the early (0-6 hours) and late (6-24 hours) postoperative periods. RESULTS: PONV incidence and scores were significantly lower in group R (5.3%) than group FR (70.6%) during the late period. Further, patients in group R ate significantly more than group FR at both lunch and dinner, and 2 patients could not ambulate the day after surgery in the FR group. There was no significant difference in analgesia requested between the 2 groups. CONCLUSIONS: We found that PCEA with ropivacaine alone resulted in a significantly lower incidence of PONV and did not disturb eating and ambulation following gynecological laparoscopic surgery, as compared to patients who received CEA.     

Postoperative enteroparesis by patient-controlled analgesia combined with continuous epidural block for patients after posterior lumbar surgery

This study evaluated postoperative enteroparesis influenced by patient-controlled analgesia combined with continuous epidural block in patients who underwent posterior lumbar surgery. One hundred nine patients were divided into three groups at random (group 1, controls (18 patients); group 2, postoperative patient-controlled analgesia and continuous epidural block (45 patients); group 3, one-shot epidural analgesia, postoperative patient-controlled analgesia, and continuous epidural block (46 patients). The patients in groups 2 and 3 had more satisfactory pain relief and needed analgesics less frequently. However, their clinical abdominal findings the morning after surgery were worse than those in control patients. The times when patients could take any nourishment and eat solid food (rice) were delayed by patient-controlled analgesia with continuous epidural block.     

Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery

BACKGROUND: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one or two epidural catheters placed intraoperatively by the surgeon has been shown to provide efficient postoperative pain control. In this prospective unblinded study, the authors compared the efficacy of continuous intravenous morphine with a continuous double epidural catheter technique with ropivacaine after scoliosis correction. METHODS: Thirty patients with American Society of Anesthesiology physical status I-III were prospectively randomized to either the morphine group or the epidural group. At the end of surgery, patients in the epidural group received two epidural catheters placed by the surgeon, one directed cephalad and one caudally. Correct placement was checked radiographically. Postoperative analgesia until the first postoperative morning was performed with remifentanil target-control infusion for all patients. From that time remifentanil was stopped and continuous intravenous analgesia with morphine or double epidural analgesia with ropivacaine 0.3% was initiated (T0 = beginning of study). Pain at rest and pain in motion (using a visual analog scale from 0-100), the amount of rescue analgesics, sensory level, motor blockade, postoperative nausea and vomiting, and pruritus were assessed every 6 h and bowel function was assessed every 12 h until T72 (end of study). Two days later, patient satisfaction was assessed. RESULTS: Pain scores at rest were significantly decreased in the epidural group at all time points except at T12, T60, and T72. Pain scores in motion were significantly decreased in the epidural group at T24, T48, and T72. Bowel activity was significantly better in the epidural group at T24, T36, T48, and T60. Postoperative nausea and vomiting and pruritus occurred significantly less frequently in the epidural group. No complications related to the epidural catheter occurred. CONCLUSIONS: Both methods provide efficient postoperative analgesia. However, double epidural catheter technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, and a higher patient satisfaction.     

Continuous intravenous infusion of pethidine or buprenorphine for postoperative analgesia

Efficacy of continuous intravenous infusion for postoperative analgesia was evaluated in 20 patients who had undergone abdominal surgery for 72 hours postoperatively. The patients were randomly allocated to two groups: one group received continuous intravenous infusion of buprenorphine at 0.2 mg.24 hr-1 using a non-electronic, portable infusor 0.5 ml.hr-1 type (Baxter), while the other received infusion of pethidine at 50 mg.hr-1. During the first 12 postoperative hours, the frequency of "Fair" rating which indicated need of supplemental analgetics was significantly higher than the later 12-hour period until 72 hours in both groups. However, although during the first 12 hours continuous intravenous infusion was inadequate to alleviate postoperative pain compared with other 12-hour period, no patient received supplemental analgesics more than 2 times. During the 24 to 72 postoperative hours, 70% of cases needed no supplemental analgesics to alleviate postoperative pain. Continuous intravenous infusion of 0.2 mg.hr-1 buprenorphine or 50 mg.hr-1 pethidine was inadequate for postoperative analgesia during immediately after the operation to 36 hours postoperatively, especially during the first 12-hour period. However, this infusion was effective during 36 to 72 postoperative hours. There was no significant difference between buprenorphine group and pethidine group.     

Plasma catecholamine levels following continuous epidural infusion of morphine for postoperative analgesia in surgical patients

Plasma catecholamine levels were measured to evaluate postoperative pain relief either with epidural morphine or systemic analgesics in sixteen patients who underwent gastrectomy. Eight patients (epidural morphine group) obtained postoperative analgesia with continuous epidural morphine with a pump (CADD-PCA, Model 5200P, Pharmacia). A bolus of morphine was administered through an indwelling thoracic (Th8 X 9) epidural catheter 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042mg.hr-1 by the pump during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) received repeatedly intravenous or intramuscular pentazocine and buprenorphine when needed. Plasma epinephrine levels increased significantly at the end of surgery in both groups, and were higher in the systemic analgesics group than those in the epidural morphine group. In the epidural morphine group, the catecholamine levels decreased to the previous day's levels on the first postoperative day and afterward, but remained high during three postoperative days in the systemic analgesics group. Plasma norepinephrine levels increased significantly at the end of surgery and afterward in both groups. However, they were significantly higher in the systemic analgesics group than in the epidural morphine group. Plasma dopamine levels were unchanged in the epidural morphine group during the surgical procedures, but they increased significantly on the first postoperative day and thereafter in the systemic analgesics group. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and exerts a suppressing effect on plasma catecholamine levels as compared with systemic analgesics regimen.     

Combined regional-general anesthesia: evaluation of remifentanil based general anesthesia and postoperative epidural analgesia

OBJECTIVES: To evaluate whether remifentanil based general anesthesia combined with epidural analgesia for postoperative pain, has any advantages with respect to consumption of drugs, blood loss, quality of pain control, hemodynamic profile, in major abdominal surgery, as compared to other combined techniques. METHODS: A retrospective study based on chart reviews of patients who have undergone colectomy, radical cystectomy and radical prostatectomy over one year period in our Institution, operated under combined regional-general anesthesia. Twenty-six patients were analyzed and were divided into three groups according to the type of anesthesia received. Group A: combined general-epidural for per-operative and postoperative pain (10 patients). Group B: combined spinal-general anesthesia (8 patients) post-operative analgesia consisted of parenteral mepiridine and paracetamol. Group C: remifentanil based general anesthesia followed by epidural for postoperative analgesia (8 patients). RESULTS: The demographic data, age and M/F distribution were comparable in the three groups. The remifentanil group showed less utilization of muscle relaxant (Cisatracurium) with respect to other groups (p < 0.001). The amount of intraoperative blood loss was not significantly different among the three groups. The efficacy of the postoperative epidural analgesia was demonstrated by the minimal utilization of analgesics (p < 0.05 and 0.01) in group A and C as compared to group B. In the group of remifentanil, the blood pressure was more stable and maintained at a systolic of 80-100 mmHg as compared to initial hypotension mainly in group C. CONCLUSION: The use of remifentanil based general anesthesia offers the advantage of non-accumulation of drugs and hemodynamic stability. Post-operative analgesia can be provided by epidural route which proved to be satisfactory in the remifentanil group. The effect on blood loss was not conclusive in this study.     

Double Epidural Catheter with Ropivacaine versus Intravenous Morphine: A Comparison for Postoperative Analgesia after Scoliosis Correction Surgery

Background: Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one or two epidural catheters placed intraoperatively by the surgeon has been shown to provide efficient postoperative pain control. In this prospective unblinded study, the authors compared the efficacy of continuous intravenous morphine with a continuous double epidural catheter technique with ropivacaine after scoliosis correction.

Methods: Thirty patients with American Society of Anesthesiology physical status I-III were prospectively randomized to either the morphine group or the epidural group. At the end of surgery, patients in the epidural group received two epidural catheters placed by the surgeon, one directed cephalad and one caudally. Correct placement was checked radiographically. Postoperative analgesia until the first postoperative morning was performed with remifentanil target-control infusion for all patients. From that time remifentanil was stopped and continuous intravenous analgesia with morphine or double epidural analgesia with ropivacaine 0.3% was initiated (T0 = beginning of study). Pain at rest and pain in motion (using a visual analog scale from 0-100), the amount of rescue analgesics, sensory level, motor blockade, postoperative nausea and vomiting, and pruritus were assessed every 6 h and bowel function was assessed every 12 h until T72 (end of study). Two days later, patient satisfaction was assessed.

Results: Pain scores at rest were significantly decreased in the epidural group at all time points except at T12, T60, and T72. Pain scores in motion were significantly decreased in the epidural group at T24, T48, and T72. Bowel activity was significantly better in the epidural group at T24, T36, T48, and T60. Postoperative nausea and vomiting and pruritus occurred significantly less frequently in the epidural group. No complications related to the epidural catheter occurred.     

Effect of continuous epidural infusion of morphine for postoperative analgesia on pituitary-adrenocortical function

Plasma levels of cortisol, ACTH and beta-endorphin like immunoreactivity (beta-ELI) were measured to evaluate postoperative pain relief with epidural morphine and systemic analgesics in conjunction with endocrine functions in 16 patients who underwent gastrectomy. Eight of these patients (epidural morphine group) obtained postoperative analgesia with continuous epidural infusion of morphine with a pump as in our previous report. A bolus of epidural morphine was administered through an indwelling thoracic (Th8,9) catheter at 3 hrs prior to the proposed end of the surgery, which was followed with continuous epidural infusion of morphine at a rate of 0.167-0.042 mg.hr-1 with a pump (CADD-PCA, Model 5200P, Pharmacia) during and after anesthesia and surgery with gradual decrease in dose until the third postoperative day. The remaining eight patients (systemic analgesics group) repeatedly received systemic pentazocine and buprenorphine when needed. Plasma cortisol levels increased significantly at the end of surgery and after in both groups. However plasma concentrations of cortisol in the epidural morphine group were significantly lower than those in the systemic analgesics group on the first and second postoperative days. Plasma levels of ACTH and beta-ELI increased significantly at the end of surgery but returned to levels of the previous day in both groups postoperatively. Our study suggests that continuous epidural infusion of morphine is adequate for postoperative pain relief and has suppressing effect on plasma cortisol levels as compared with systemic analgesics regimen.     

Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy

This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. In the epidural group, the times for first passing of flatus (31 +/- 22 hours; mean +/- SD) and feces (70 +/- 44 hours) were significantly shorter than in the control group (flatus 58 +/- 14 hours and feces 103 +/- 26 hours). The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.     

Effect of epidural analgesia on postoperative paralytic ileus in chronic schizophrenia

BACKGROUND AND OBJECTIVES: Postoperative paralytic ileus is frequently encountered in chronic schizophrenic patients who undergo abdominal surgery. We investigated whether epidural analgesia with local anesthetics minimizes postoperative ileus in schizophrenic patients who are treated long term with antipsychotic drugs. METHODS: We measured the VAS pain after surgery and the time that elapsed before the first passage of flatus and/or feces after the end of surgery in schizophrenic patients provided analgesia with systemic buprenorphine (group A) and schizophrenic patients receiving epidural analgesia with local anesthetics (group B). RESULTS: The frequency of patients who did not pass flatus and/or feces for more than 120 hours postoperatively was significantly higher in group A. Postoperative pain scores of group A at 8 and 24 hours after the end of anesthesia were 36.0 +/- 12.8 and 31.7 +/- 10.7 (0 to 100 mm scale), which were significantly higher than 25.4 +/- 13.2 and 20.5 +/- 9.4 scores in group B. CONCLUSIONS: Epidural analgesia with local anesthetics in chronic schizophrenic patients undergoing abdominal surgery minimizes postoperative ileus compared to patients receiving systemic buprenorphine.     

Postoperative outcome of open donor nephrectomy under epidural analgesia: a descriptive analysis

PURPOSE: Patients subjected to open donor nephrectomy with epidural analgesia were analyzed to determine whether there was a relation between catheter placement site and the appearance of complications and satisfactory analgesia and to determine whether this factor had an impact upon recovery and return to preoperative life. METHODS: A cohort of 36 open donor nephrectomies were performed with postoperative epidural analgesia. Two groups were analyzed: thoracic (22 patients) and lumbar catheters (14 patients). There was a 72-hour evaluation followed by phone contact. Besides detecting related complications pain was evaluated using a visual analog scale (VAS 0 to 10) in the postanesthesia care unit and at 6, 24, 48 and 72 hours postoperatively. Satisfactory analgesia was defined as a VAS of 3 or less. RESULTS: In all cases the analgesic solution was composed of bupivacaine 0.125% with an opioid in 97%. Patients showed complications in 72% (26/36); the only significant association was motor blockade in the lumbar group (21% vs 0% in the thoracic, P = .023). Patients had a mean VAS of 2.83 +/- 1.77. There was a larger proportion of pain-free patients (VAS 0) in the thoracic group; in addition, there was no VAS of 10 in this group. Ambulation was resumed in less than 24 hours in 57% of patients, having a mean VAS of 2.1 +/- 1.5 compared with 3.2 +/- 1.6 among those who ambulated after 24 hours (P = .04). There was no association between perioperative pain control and the interval to normal activities. CONCLUSIONS: Without a control group, we can hardly evaluate the impact of epidural analgesia on perioperative outcome. Notwithstanding, the obtained pain control may justify its use in these patients. An important issue is to maintain a low VAS (<3), especially in the first 24 hours, which may make a clinically important difference for early ambulation.     

A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.     

The effect of epidural somatostatin on postoperative pain

The epidural injection of a bolus of 250 micrograms somatostatin followed by continuous epidural infusion provided complete postoperative relief of pain in eight patients who had undergone abdominal surgery; no other analgesics were required. In two patients, intravenous and intramuscular naloxone had no effect on the analgesia provided by epidural somatostatin. In two patients, epidural somatostatin also produced adequate intraoperative analgesia. Epidural somatostatin was associated with no side effects.     

Effect of epidural anesthesia and analgesia on perioperative outcome: a randomized, controlled Veterans Affairs cooperative study

OBJECTIVE: To test the hypothesis that epidural anesthesia and postoperative epidural analgesia decrease the incidence of death and major complications during and after four types of intraabdominal surgical procedures. SUMMARY BACKGROUND DATA: Even though many beneficial aspects of epidural anesthesia have been reported, clinical trials of epidural anesthesia for outcome of surgical patients have shown conflicting results. METHODS: The authors studied 1,021 patients who required anesthesia for one of the intraabdominal aortic, gastric, biliary, or colon operations. They were assigned randomly to receive either general anesthesia and postoperative analgesia with parenteral opioids (group 1) or epidural plus light general anesthesia and postoperative epidural morphine (group 2). The patients were monitored for death and major complications during and for 30 days after surgery, as well as for postoperative pain, time of ambulation, and length of hospital stay. RESULTS: Overall, there was no significant difference in the incidence of death and major complications between the two groups. For abdominal aortic surgical patients, unlike the other three types of surgical patients, the overall incidence of death and major complications was significantly lower in group 2 patients (22%) than in group 1 patients (37%), stemming from differences in the incidence of new myocardial infarction, stroke, and respiratory failure between the two groups. Overall, group 2 patients received significantly less analgesic medication but had better pain relief than group 1 patients. In group 2 aortic patients, endotracheal intubation time was 13 hours shorter and surgical intensive care stay was 3.5 hours shorter. CONCLUSIONS: The effect of anesthetic and postoperative analgesic techniques on perioperative outcome varies with the type of operation performed. Overall, epidural analgesia provides better postoperative pain relief. Epidural anesthesia and epidural analgesia improve the overall outcome and shorten the intubation time and intensive care stay in patients undergoing abdominal aortic operations.     

Postoperative analgesia after radical retropubic prostatectomy: a double-blind comparison between low thoracic epidural and patient-controlled intravenous analgesia

BACKGROUND: Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study. METHODS: Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient-controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postoperatively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 microg/ml fentanyl, and 2 microg/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intravenous analgesia pump intravenously. Patients in group P received a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and "deep" visceral pain) and on coughing. Secondary outcome variables included gastrointestinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fentanyl was measured in five patients to exclude a systemic effect of fentanyl. RESULTS: Incisional pain and pain on coughing were lower in group E compared with group P at 2-24 h, as was deep pain between 3 and 24 h postoperatively (P < 0.05). Maximum expiratory pressure was greater in group E at 4 and 24 h (P < 0.05) compared with group P. No difference in time to home discharge was found between the groups. The mean plasma fentanyl concentration varied from 0.2 to 0.3 ng/ml during 0-48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group x time interaction was found in the Short Form-36. CONCLUSIONS: The authors found evidence for better pain relief and improved expiratory muscle function in patients receiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.     

Epidural block with mepivacaine before surgery reduces long-term post-thoracotomy pain

PURPOSE: To examine the effect of continuous epidural block initiated before thoracic surgery upon early and long-term postoperative pain. METHODS: In a double-blind study, 70 patients scheduled for thoracic surgery under general anesthesia were assigned randomly to receive continuous epidural block with mepivacaine 1.5% initiated either 20 min before surgical incision (Pre group) or at completion of surgery (Post group). In both groups the initial dose was 4 ml, followed by a continuous infusion at 4 ml x hr(-1) until 72 hr after operation. Indomethacin suppositories, 50 mg, were administered on request as supplementary analgesics. Visual analogue scale at rest was assessed four hours after operation, and then every 24 hr after operation on postoperative days 1 through 7, and also days 14 and 30. At three and six months after operation, all patients were interviewed by telephone with respect to postoperative pain. The most severe pain was assessed using modified numerical rating scale. RESULTS: By a visual analogue scale, postoperative pain was less in the Pre group than in the Post group at four hours, two and three days after operation (P < 0.05). By a numerical rating scale six months after operation, pain was less in the Pre group than in the Post group (P = 0.015). The percentage of pain-free patients was higher in the Pre group than in the Post group at three (P = 0.035) and six (P = 0.0086) months after operation. CONCLUSION: Continuous epidural block initiated prior to surgery may reduce long-term post-thoracotomy pain.