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Reduced Postoperative Analgesic Demand After Inhaled Anesthesia in Comparison to Combined Epidural-Inhaled Anesthesia in Patients Undergoing Abdominal Surgery

1997; Lippincott Williams & Wilkins; Volume: 84; Issue: 3 Linguagem: Inglês

10.1097/00000539-199703000-00025

1526-7598

M. Rockemann, W. Seeling, Svenja Pressler, Peter R. P. Steffen, Michael Georgieff,

Anesthesia and Sedative Agents

We studied the effect of epidural/general combination anesthesia, in comparison to inhaled anesthesia, on postoperative pain and analgesic consumption in patients undergoing upper abdominal surgery.Anesthesia was induced with propofol and maintained with enflurane in 70% N2 O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.25% 0.2 mL/kg and sufentanil 1 micro g/kg 65 +/- 3 min before dermal incision and 0.1 mL/kg bupivacaine 0.25% + sufentanil 2 micro g/mL (BS) every hour thereafter. Group II received 0.2 mL/kg of BS 316 +/- 15 min after dermal incision in the recovery room. Postoperative patient-controlled epidural analgesia (PCEA) with BS was provided. Pain intensities and consumption of PCEA BS were recorded on postoperative days (PODs) 1 to 5. Inspiratory fraction of enflurane was lower (0.5% +/- 0.01% vs 1.6% +/- 0.04%; P < 0.001) in Group I compared with Group II. Cumulative postoperative consumption of PCEA BS was higher in Group I compared with Group II from the evening of POD 2 until the end of the study (301 +/- 19 mL vs 249 +/- 17 mL; P < 0.001), while pain intensities were comparable at all times. The intraoperative effects of combined BS and enflurane/N2 O (inspiratory fraction [Fi] [approximately] 1 minimum alveolar anesthetic concentration [MAC]) did not preempt postoperative pain in contrast to enflurane/N2 O anesthesia (Fi [approximately] 2.8 MAC). (Anesth Analg 1997;84:600-5)