Does Pre-emptive Epidural Analgesia Improve the Degree and the Quality of Postoperative Pain Relief in Patients Undergoing Upper Abdominal Laparotomy?

The present prospective study was designed to compare the effects of pre-vs. postoper-ative commencement of continuous epidural analgesia on postoperative pain relief and comfort. Forty one patients scheduled for upper abdominal surgery under general anesthe-sia were randomly assigned to receive epidural analgesia starting either before the skin incision (A group, n=21) or at the closure of the peritonium (B group, n=20). An epidural catheter was placed between T8 and T12 intervertebral level corresponding to each surgical field. Epidural analgesia was performed as follows: 5 to 7ml of 1% mepivacaine initially followed by infusion of a total of 96ml of solution containing bupivacaine (2.5mg•ml-1) and buprenorphine (4.2μg•ml-1)over 48 hours at 2ml•h-1 with a ballon reservoir. There were no significant differences in the postoperative vital signs, visual analogue scales both at rest and at movement, verbal pain scores, additional analgesics, conscious level, comfort, and recovery of the intestinal and motor functions. In conclusion, the present results show that the pre-operative start of epidural analgesia is not always beneficial for patients undergoing upper abdominal surgery compared with the post-operative start, questioning the efficacy of pre-emptive epidural analgesia under general anesthesia.