Pre-emptive effect of epidural sufentanil in abdominal hysterectomy

Background. Experimental studies suggest pre-emptive administrationof analgesics is effective but clinical evidence is less convincing. Methods. Forty-one patients undergoing abdominal hysterectomywere allocated randomly in a double-blind fashion to receivesufentanil 50 µg via a lumbar epidural catheter beforeor at the end of surgery. Results. Sufentanil consumption from a patient-controlled epiduralanalgesia (PCEA) system and numerical pain scores at rest andduring movement over the initial 72 h were similar in thetwo groups. When the study period was divided into five timeintervals, sufentanil consumption in the pre-emptive group wassignificantly less than in the control group between 8 and 16 hafter surgery (P=0.04). Furthermore, the number of failed bolusattempts from the PCEA device was significantly lower and patientsatisfaction was significantly better in the pre-emptive groupduring the 72 h of PCEA treatment (P<0.05). In addition,the median decrease in ACTH and cortisol on the first postoperativemorning relative to baseline values was greater in the pre-emptivegroup than in the control group (P<0.05). In subjects whohad a Pfannenstiel incision, touch and pain sensitivity in thewound area were less in the pre-emptive group over the first4 postoperative days (P<0.05). Conclusions. We conclude that pre-emptive analgesia with epiduralsufentanil was associated with a short-term sufentanil-sparingeffect, and could have reduced stress hormone responses andwound sensitization after abdominal hysterectomy. Br J Anaesth 2002; 88: 803–8