Hemodynamic and Preemptive Analgesic Effect of Preoperative Epidural Analgesia during Laparoscopic Hysterectomy / 대한마취과학회지

ABSTRACT

BACKGROUND: A laparoscopic hysterectomy is gaining popularity on account of its many benefits. The trendelenburg position and pneumoperitoneum necessary for a laparoscopy causes intraoperative hemodynamic fluctuations. The aim of this study was to evaluate the intraoperative hemodynamic and postoperative analgesic effects of preemptive epidural analgesia in a laparoscopic hysterectomy. METHODS: Fifty ASA 1 and 2 patients were randomized to two groups. Nothing was applied to the control group before inducing general anesthesia. In the epidural group, an epidural catheter was inserted through the L2-3 space and 1% lidocaine 10 ml was injected. The blood pressures, heart rates, cardiac outputs, stroke volumes and cardiac indexes were measured using NICO(TM) (Non-Invasive Cardiac Output using partial carbon dioxide rebreathing technique, fast mode, Novametrix Medical Systems Inc, USA) at time before induction (T1), post-intubation (T2), post-insufflation and in the trendelenburg position (T3), post-intubation 10 (T4), 20 (T5), 30 (T6) and 60 minutes (T7), post-exsufflation (T8) and post-neutral position (T9). The pain scores were assessed by the patients using a 100 mm visual analogue scale at 1, 3, 6, 12 and 24 hours postoperatively. RESULTS: There were important differences in the blood pressures, cardiac outputs, stroke volumes and cardiac indexes between the two groups. No significant changes in the heart rate were observed during surgery in either groups. The postoperative pain scores were significantly lower in the epidural group compared with the control group. CONCLUSIONS: Preemptive epidural analgesia produces a more stable hemodynamic state during a laparoscopic hysterectomy and reduces the level of postoperative pain.