• E I Akural, T E Salomäki, A H Tekay, A H Bloigu, and S M Alahuhta.
• Department of Anaesthesiology, University Hospital of Oulu, PO Box 5000, FIN-90014, University of Oulu, Oulu, Finland.
• Br J Anaesth. 2002 Jun 1;88(6):803-8.

BackgroundExperimental studies suggest pre-emptive administration of analgesics is effective but clinical evidence is less convincing.MethodsForty-one patients undergoing abdominal hysterectomy were allocated randomly in a double-blind fashion to receive sufentanil 50 micrograms via a lumbar epidural catheter before or at the end of surgery.ResultsSufentanil consumption from a patient-controlled epidural analgesia (PCEA) system and numerical pain scores at rest and during movement over the initial 72 h were similar in the two groups. When the study period was divided into five time intervals, sufentanil consumption in the pre-emptive group was significantly less than in the control group between 8 and 16 h after surgery (P = 0.04). Furthermore, the number of failed bolus attempts from the PCEA device was significantly lower and patient satisfaction was significantly better in the pre-emptive group during the 72 h of PCEA treatment (P < 0.05). In addition, the median decrease in ACTH and cortisol on the first postoperative morning relative to baseline values was greater in the pre-emptive group than in the control group (P < 0.05). In subjects who had a Pfannenstiel incision, touch and pain sensitivity in the wound area were less in the pre-emptive group over the first 4 postoperative days (P < 0.05).ConclusionsWe conclude that pre-emptive analgesia with epidural sufentanil was associated with a short-term sufentanil-sparing effect, and could have reduced stress hormone responses and wound sensitization after abdominal hysterectomy.

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