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A comparison of the effects on postoperative pain relief of epidural analgesia started before or after surgery

Published online by Cambridge University Press:  16 August 2006

P. Flisberg ,
K. Törnebrandt ,
B. Walther  and
J. Lundberg
P. Flisberg
Affiliation:
Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, SE-221 85 Lund, Sweden
K. Törnebrandt
Affiliation:
Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
B. Walther
Affiliation:
Department of Surgery, Lund University Hospital, Lund, SE-221 85 Lund, Sweden
J. Lundberg
Affiliation:
Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, SE-221 85 Lund, Sweden
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Abstract

In a randomized, prospective clinical study pain relief and pulmonary function were compared after upper abdominal surgery when thoracic epidural analgesia was instituted either before or after surgery. Twenty-six patients admitted for surgery to treat gastro-oesophageal reflux received thoracic epidural analgesia as an adjunct to general anaesthesia either before or after surgery. Twelve patients received epidural mepivacaine 20 mg mL−1 and morphine perioperatively. Another 14 patients received an epidural bolus of bupivacaine 2.5 mg mL−1 and morphine after skin closure. Bupivacaine 2.5 mg mL−1 with morphine was adminstered to all patients for three postoperative days. No intergroup differences were found regarding pain at rest and mobilization. The requirement for additional analgesics was similar in both groups as well as peak expiratory flow. Thoracic epidural analgesia that had already been induced before surgery, and was continued into the postoperative period, does not seem to add any advantage regarding pain relief and lung function compared with thoracic epidural analgesia instituted in the immediate postoperative period.

Keywords

anaesthetic techniquethoracic epiduralanaesthetics localbupivacainemepivacaineopioidsepiduralmorphinepainpostoperativesurgeryupper abdominal
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 17 , Issue 10 , October 2000 , pp. 627 - 633
Copyright
2000 European Society of Anaesthesiology

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