Combined epidural-spinal opioid-free anaesthesia and analgesia for hysterectomy

Postoperative nausea and vomiting (PONV) are major problems after gynaecolo gical surgery. We studied 40 patients undergoing total abdominal hysterecto my, allocated randomly to receive opioid-free epidural-spinal anaesthesia o r general anaesthesia with continuous epidural bupivacaine 15 mg h(-1) or c ontinuous bupivacaine 10 mg h(-1) with epidural morphine 0.2 mg h(-1), resp ectively, for postoperative analgesia. Nausea, vomiting, pain and bowel fun ction were scored on 4-point scales for 3 days. Patients undergoing general anaesthesia had significantly higher nausea and vomiting scores (P<0.01) b ut significantly lower pain scores during rest (P<0.05) and mobilization (P <0.01). More patients undergoing general anaesthesia received antiemetics ( 13 vs five; P<0.05), but fewer received supplementary opioids on the ward ( eight vs 16; P<0.05). We conclude that opioid-free epidural-spinal anaesthe sia for hysterectomy caused less PONV, but with less effective analgesia co mpared with general anaesthesia with postoperative continuous epidural morp hine and bupivacaine.