DOES PRE-INCISIONAL THORACIC EXTRADURAL BLOCK COMBINED WITH DICLOFENAC REDUCE POSTOPERATIVE PAIN AFTER ABDOMINAL HYSTERECTOMY

In a double-blind, randomized study, we investigated 40 patients under going abdominal hysterectomy; patients received 0.5% plain bupivacaine 20 mi via a low thoracic extradural catheter and a diclofenac supposi tory (100 mg), either 30 min before incision (group 1) or 30 min after incision (group 2). All patients received a standard general anaesthe tic and no opioid was used before or during operation. Postoperative a nalgesic requirements were measured using a patient-controlled analges ia (PCA) system. Pain was assessed using a visual analogue scale (VAS) and a verbal pain score (VPS) on movement up to 48 h after operation. There was no significant difference in the time to first request for morphine but consumption of morphine was significantly greater in grou p 1 at all times except 24 h. There were no significant differences in VAS and VPS pain scores, although both scores were consistently highe r in group 1. Patient satisfaction with the quality of analgesia, at 2 4 h, demonstrated no significant difference between the two groups. Th e combination of extradural block and diclofenac suppository given bef ore operation did not appear to produce a clinically effective pre-emp tive analgesic effect.