Abstract
We investigated the effects of epidural analgesia and general anesthesia on the postoperative pain after laparoscopic cholecystectomy. Eleven patients (group E) received epidural anesthesia with mepivacaine during surgery followed by bolus epidural buprenorphine (3μug/kg) only. Another twenty-four patients were randomly allocated into two groups: Group EB (n=12) received epidural anesthesia with mepivacaine during surgery followed by continuous epidural buprenorphine (12μg/h) for 24 hours postoperatively; Group GB (n=12) received general anesthesia with isoflurane and received continuous epidural buprenorphine (12μg/h) for 24 hours postoperatively. At the end of the operation, all patients received epidural bolus administration of buprenorphine (3μg/kg). Postoperative pain score (VAS: Visual Analogue Scale) and supplemental analgesics (indomethacin suppository and pentazocine i. m.) use were compared.
The VAS values (mm: median [range]) at rest 24, 48, and 72 hours after operation were 8 (0-51), 7 (0-31), and 5 (0-25), respectively, for Group E, and 6 (0-21), 0 (0-21), and 0 (0-0), respectively, for Group GB. Those were all zero for Group EB. The VAS values at rest 24 and 48 hours after operation for group EB were significantly lower (p<0.01) than those for Group GB. The VAS values on movement, there was no significant different between Groups GB and EB at 24, 48 and 72 hours after operation. Ten of 11 patients (91%) for Group E and nine of the 12 patients (75%) for Group GB needed supplemental analgesics. On the other hand, only one of the 12 patients (8%) for group EB consumed supplemental analgesics (p<0.001).
We conclude that, although intraoperative epidural analgesia can reduce postoperative pain after laparoscopic cholecystectomy, pain relieving strategy should be taken at least during the first 24 hours after laparoscopic cholecystectomy even under intraoperative epidural analgesia.
