High dose alfentanil pre-empts pain after abdominal hysterectomy

Abstract

Summary This study tested the hypothesis that high dose systemic alfentanil administered before and during aMominal hysterectomy would pre-empt post'operative pain to a greater extent than administration of either low dose alfentanil or no alfentanil perioperatively. Patients (ASA I or 2) were randomly assigned to group 1 (r = 15), no opioid; group 2 (n = 15), low dose alfentanil; or group 3 (n = l5). high dose alfentanil. Anaesthesia was induced in group I with midazolam and thiopentone and was maintained with isoflurane andTO% N2O in 02, Anaesthesia was induced in group 2 with midazolam, thiopentone and i.v. alfentanil (30pg kg-l), and was maintained with isoflurane. 70VoN2O in 02, and bolus doses of i.v. alfentanil (10-20pg kg-l) every hour. Anaesthesia was induced in group 3 withmidazolamandi.v. alfentanl (l0opgkg-t),and wasmaintained wtlt70% N2Oin Oz,andanintusionof i.v. alfentanil(l-2pgkg-l min-l). Blood samples were drawn at 30 and 120 min after surgery and assayed for plasma alfentanil. Morphine consumption and VAS pain scores were consistently lowest in group 3 over the 48 h study period, A composite measure of pain and morphine consumption was significantly lower in group 3 than group 2 up to 6 h after surgery and significantly lower than group I up to 12 h. No adverse effects were observed. A 6-month follow-up did not reveal any significant differences among the three groups. It is concluded that intra-operative high dose alfentanil anaesthetic pre-empts post-oporative pain after abdominal hysterectomy, but the effects are small and of short duration.Surgical procedures carried out under general anaesthesia using standard (and even high) doses of opioids intraoperatively provide suboptimal protection from the injury banage brought about by incision and subsequent noxious surgical events.

Impact of Perioperative Pain Intensity, Pain Qualities, and Opioid Use on Chronic Pain After Surgery

“…For clinicians, the primary message is the need to consider preoperative and early postoperative pain as the fifth vital sign with respect to improving outcomes after surgery. Despite previous observations that more effective treatment of early postoperative pain does not necessarily prevent the development of CPSP, 29 continued attempts to better manage postgynecologic surgery pain in high-risk women (eg, preoperative pain and high state anxiety) are needed in CPSP prevention trials. Clinicians should be aware of the potentially poor outcomes in these women.…”

Research design considerations for chronic pain prevention clinical trials

“…Various trials have assessed CPSP with less specific movement, for instance “while coughing” [125,165], “during daily activities” [12], “while moving” [88,170] or during a defined movement protocol [3]. Procedure-specific validated assessments of pain-related functional consequences, such as those described for hernia surgery [54], thoracic surgery [140], and breast [4] surgery, have been developed.…”

“…If the pain qualities are different before and after surgery, the pain can more confidently be attributed to the surgery. Multiple studies have included neuropathic pain measures as CPSP study outcomes [12,19,27,33,51,65,67,78,88,108]. …”

Locally Administered Ketorolac and Bupivacaine for Control of Postoperative Pain in Breast Augmentation Patients

“…It has since been recognized that the nociceptive neuron blockade of systemic opioids is insufficient to block central sensitization. 6 Although general anesthesia may attenuate the massive afferent stimulation produced by surgery, it does not block it. 7 In contrast, the spinal cord receives few or none of the afferent impulses set off during surgery when under regional anesthesia.…”