REDUCED POSTOPERATIVE ANALGESIC DEMAND AFTER INHALED ANESTHESIA IN COMPARISON TO COMBINED EPIDURAL-INHALED ANESTHESIA IN PATIENTS UNDERGOING ABDOMINAL-SURGERY

We studied the effect of epidural/general combination anesthesia, in c omparison to inhaled anesthesia, on postoperative pain and analgesic c onsumption in patients undergoing upper abdominal surgery. Anesthesia was induced with propofol and maintained with enflurane in 70% N2O as necessary to maintain arterial blood pressure within 20% of baseline. Group I received bupivacaine 0.25% 0.2 mL/kg and sufentanil 1 mu g/kg 65 +/- 3 min before dermal incision and 0.1 mL/kg bupivacaine 0.25% sufentanil 2 mu 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 w as provided. Pain intensities and consumption of PCEA BS were recorded on postoperative days (PODs) 1 to 5. Inspiratory fraction of enfluran e was lower (0.5% +/- 0.01% vs 1.6% +/- 0.04%; P < 0.001) in Group I c ompared 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 mt vs 249 +/- 17 mt; P < 0.00 1), while pain intensities were comparable at all times. The intraoper ative effects of combined BS and enflurane/N2O (inspiratory fraction [ F-i] similar to 1 minimum alveolar anesthetic concentration [MAC]) did not preempt postoperative pain in contrast to enflurane/N2O anesthesi a (F-i similar to 2.8 MAC).