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Preoperative spinal bupivacaine does not reduce postoperative morphine requirement in women undergoing total
M J Dakin1, O Y Osinubi, F Carli
1Department of Anaesthesia, Northwick Park Hospital, Harrow, Middlesex, England.
Background And Objectives:
This study was undertaken to determine whether preoperative spinal anesthesia with local anesthetics would exert a pre-emptive effect on postoperative analgesia by reducing neural afferent stimulation.
Methods:
The authors studied 38 healthy women undergoing total abdominal hysterectomy. Patients were randomly allocated to two groups: group A received a spinal block (T3-S5) prior to induction of anesthesia and surgery, while in group B the block was performed after surgery prior to extubation of the trachea. Patient-controlled analgesia morphine was administered to both groups during the first 24 postoperative hours.
Results:
Pain and sedation scores at 6, 12, and 24 hours were similar in the two groups. Cumulative morphine consumption at 6 and 24 hours after surgery was similar in both groups; however at 12 hours more morphine was needed in group A (P < .02).
Conclusions:
The authors were unable to demonstrate that spinal block with bupivacaine before surgery, as opposed to after surgery, decreased the requirement of morphine in the postoperative period.