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Postoperative analgesia after radical retropubic prostatectomy: a double-blind comparison between low thoracic epidural and patient-controlled intravenous analgesia
Örebro University, School of Health and Medical Sciences.ORCID iD: 0000-0001-6128-7752
Örebro University, School of Health and Medical Sciences.
Örebro University, School of Health and Medical Sciences.
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2006 (English)In: Anesthesiology, ISSN 0003-3022, E-ISSN 1528-1175, Vol. 105, no 4, 784-793 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Postoperative pain after radical retropubic prostatectomy can be severe unless adequately treated. Low thoracic epidural analgesia and patient-controlled intravenous analgesia were compared in this double-blind, randomized study.

METHODS: Sixty patients were randomly assigned to receive either low thoracic epidural analgesia (group E) or patient-controlled intravenous analgesia (group P) for postoperative pain relief. All patients had general anesthesia combined with thoracic epidural analgesia during the operation. Postoperatively, patients in group E received an infusion of 1 mg/ml ropivacaine, 2 microg/ml fentanyl, and 2 microg/ml adrenaline, 10 ml/h during 48 h epidurally, and a placebo patient-controlled intravenous analgesia pump intravenously. Patients in group P received a patient-controlled intravenous analgesia pump with morphine intravenously and 10 ml/h placebo epidurally. Pain, the primary outcome variable, was measured using the numeric rating scale at rest (incision pain and "deep" visceral pain) and on coughing. Secondary outcome variables included gastrointestinal function, respiratory function, mobilization, and full recovery. Health-related quality of life was measured using the Short Form-36 questionnaire, and plasma concentration of fentanyl was measured in five patients to exclude a systemic effect of fentanyl.

RESULTS: Incisional pain and pain on coughing were lower in group E compared with group P at 2-24 h, as was deep pain between 3 and 24 h postoperatively (P < 0.05). Maximum expiratory pressure was greater in group E at 4 and 24 h (P < 0.05) compared with group P. No difference in time to home discharge was found between the groups. The mean plasma fentanyl concentration varied from 0.2 to 0.3 ng/ml during 0-48 h postoperatively. At 1 month, the scores on emotional role, physical functioning, and general health of the Short Form-36 were higher in group E compared with group P. However, no group x time interaction was found in the Short Form-36.

CONCLUSIONS: The authors found evidence for better pain relief and improved expiratory muscle function in patients receiving low thoracic epidural analgesia compared with patient-controlled analgesia for radical retropubic prostatectomy. Low thoracic epidural analgesia can be recommended as a good method for postoperative analgesia after abdominal surgery.

Place, publisher, year, edition, pages
Wolters Kluwer, 2006. Vol. 105, no 4, 784-793 p.
National Category
Medical and Health Sciences Anesthesiology and Intensive Care Surgery
Research subject
Anaesthesiology; Surgery
Identifiers
URN: urn:nbn:se:oru:diva-11124ISI: 000240932400024PubMedID: 17006078OAI: oai:DiVA.org:oru-11124DiVA: diva2:324950
Available from: 2010-06-16 Created: 2010-06-16 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Optimization of the perioperative anaesthetic care for prostate cancer surgery: clinical studies on pain, stress response and immunomodulation
Open this publication in new window or tab >>Optimization of the perioperative anaesthetic care for prostate cancer surgery: clinical studies on pain, stress response and immunomodulation
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Prostate cancer (PC) is the most common cancer form in men. Surgery is the treatment of choice for localized form of PC and half of all surgical procedures are radical retropubic prostatectomies (RRP). In the first two studies, we compared the efficacy of thoracic epidural analgesia to patientcontrolled analgesia (PCA) with intravenous morphine (I) and to patientcontrolled local analgesia by intra-abdominal injection of local anaesthetic(LA) (II) in treating postoperative pain after RRP. In studies III and IV we evaluated the effects of thoracic epidural analgesia compared to PCA with morphine in reducing the surgical stress reaction, inflammatory response (III) as well as the immune suppression (IV) following RRP. In studies I and II, we found better pain relief both at rest and on coughing, lower morphine consumption and better respiratory function postoperatively in patients having epidural analgesia. However, we did not register differences in time to home readiness or length of hospital stay. Painmanagement did not significantly affect health-related quality of life. In study III, early surgical stress response (plasma glucose and cortisol) was reduced two hours after the skin incision in patients having epidural analgesia compared with those having intravenous morphine analgesia but no differences in inflammatory mediators were seen except IL-17 which was lower in the epidural group. In study IV, no differences were found between epidural and PCA groups in leucocyte subpopulations, immunecell activation after mitogen stimulation or in natural killer cell cytotoxicityas a measure of innate immunity. We observed a low incidence of side effects and postoperative complications in all studies with no differences between the groups. In summary, thoracic epidural analgesia provided better postoperative pain relief, improved respiratory function and reduction in early stress response to radical retropubic prostatectomy, without any significant effects on inflammation or immune suppression.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. 97 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 69
Keyword
Radical retropubic prostatectomy, epidural analgesia, patientcontrolled local anaesthesia, patient-controlled analgesia, surgical stress response, local and general inflammatory reaction, immune response
National Category
Medical and Health Sciences Anesthesiology and Intensive Care Surgery
Research subject
Anaesthesiology; Surgery
Identifiers
urn:nbn:se:oru:diva-22804 (URN)978-91-7668-873-1 (ISBN)
Public defence
2012-06-07, Wilandersalen, M-huset, Universitetssjukhuset, Örebro, 09:00 (English)
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Available from: 2012-05-10 Created: 2012-05-10 Last updated: 2017-10-17Bibliographically approved

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Gupta, AnilFant, FedericaAxelsson, KjellJohansson, Jan-ErikAndersson, Swen-Olof

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