Effect of peri- and postoperative epidural anaesthesia on pain and gastrointestinal function after abdominal hysterectomy

In a double blind study we have investigated the effects of epidural local anaesthesia (LA), when added to general anaesthesia (GA) and postoperative paracetamol and NSAID, on postoperative pain and gastrointestinal function in patients undergoing open hysterectomy. Sixty patients were randomized in to three study groups: GA, and postoperative paracetamol and NSAID (GA, n=2 0); GA, paracetamol, NSAID, intraoperative epidural lidocaine and 24-h post operative epidural saline (Saline, n=20); or GA, paracetamol, NSAID, intrao perative epidural lidocaine and 24-h postoperative epidural bupivacaine (Bu pi, n=20). Patients were observed for 72 h postoperatively. Pain at rest, d uring cough, and mobilization, request for supplementary morphine, and time to first postoperative flatus, was reduced in patients receiving 24-h post operative epidural anaesthesia, compared with the two other groups. However , these effects of epidural LA, were not sustained beyond the period of inf usion, and no differences in PONV, time to first postoperative defecation, mobilization or time to discharge from hospital were observed between group s. A 24 h postoperative epidural infusion with bupivacaine, when added to p ostoperative paracetamol and NSAID, reduces pain and opioid requirements, b ut has only limited effects on gastrointestinal function and patient recove ry.