J Korean Pain Soc.  1999 May;12(1):21-26.

Effects of Preopertive Epidural Block with Low Dose Bupivacaine and Morphine on Postoperative Pain, Plasma Cortisol and Serum Glucose in Total Abdominal Hysterectomy

• Park HS
• Lee SC
• Cha MS

Abstract

BACKGROUND: Preoperative blocking of surgical nociceptive inputs may prevent sensitization of central nervous system (CNS) and reduce postoperative pain. The stress responses to surgical trauma consist of increase in catabolic hormones and decrease in anabolic hormones. We studied whether preoperative low dose epidural bupivacaine and morphine could affect postoperative pain, changes plasma cortisol, and serum glucose.
METHODS
Thirty patients undergoing total abdominal hysterectomy were randomly assigned to one of three groups. General anesthesia was induced in all patients and after that, epidural blocks were done except the control group (n=10) patients. Preoperative block group (n=10) received 0.5% bupivacaine 50 mg and morphine 2 mg epidurally as a bolus before operation and followed by 0.1% bupivacaine 5 mghr-1 and morphine 0.2 mghr-1 for 10 hours. Postoperative block group (n=10) received the same doses of bupivacaine and morphine under the same method postoperatively. Postoperative pain relief was provided with i.v. fentanyl through Patient-Controlled-Analgesia Pump. Postoperative pain by visual analogue scores (VAS), analgesic requirement (first requirement time, total amounts used), side effects, plasma cortisol level and serum glucose level were compared.
RESULTS
Until postoperative 6 hrs, VAS of control group was higher than those of the epidural groups. No difference was observed in VAS between the two epidural groups. First analgesics requirement time and total amounts of used analgesics were not different between the two epidural groups, but first analgesic requirement time of preoperative block group was significantly prolonged compared with control group. Plasma cortisol and serum glucose levels were not different among groups.
CONCLUSIONS
Low dose preoperative epidural bupivacaine and morphine could not reduce postoperative pain, plasma cortisol level and serum glucose level compared with postoperative block group.

Keyword

Analgesia, epidural; Pain, postoperative; Surgical stress, plasma cortisol, serum glucose

MeSH Terms

Analgesia, Epidural
Analgesics
Anesthesia, General
Blood Glucose*
Bupivacaine*
Central Nervous System
Fentanyl
Humans
Hydrocortisone*
Hysterectomy*
Morphine*
Pain, Postoperative*
Plasma*
Analgesics
Bupivacaine
Fentanyl
Hydrocortisone
Morphine