A comparison of pre-emptive with preventive epidural analgesia in the patients undergoing major gynecologic surgery

Pain management is a crucial component in the care of the postoperative patient. Although pre-emptive analgesia is commonly used for the management of postoperative pain, timing the analgesic administration is unclear. This study was designed to compare the efficacy of pre-emptive epidural analgesia (EA) with preventive EA in the patients undergoing major gynecologic surgery. A randomized, double-blinded trial was performed in 50 women of physical status American Society of Anesthesiologists (ASA) 1-3 undergoing major gynecologic surgery. Prior to induction of general anesthesia an epidural catheter was inserted in the patients of the two groups. Patients were allocated randomly into one of two groups; pre-emptive group (n = 25) received 12 ml of 0.125% bupivacaine and 50 µg fentanyl epidurally 20 min before the incision of surgery and the preventive group (n = 25) received the same of agents 20 min before the end of surgery via the epidural catheter. Preventive compared to pre-emptive EA had a significantly increased interval between the analgesic requests (P<0.001). The preventive group compared to the pre-emptive group had significantly decreased postoperative visual analog scale (VAS) in post anesthesia care unit (PACU) and up to 3 h after surgery (P<0.001). A preventive EA before the end of operation provides an improved postoperative analgesia in comparison to pre-emptive EA with no side effects in patients undergoing major gynecologic surgery.   Key words: Gynecologic surgery, postoperative pain, epidural administration, pre-emptive analgesia, bupivacaine, fentanyl.