Preemptive Epidural Analgesia and Recovery From Radical Prostatectomy: A Randomized Controlled Trial

Preemptive Epidural Analgesia and Recovery From Radical Prostatectomy: A Randomized Controlled Trial

CONTEXT.— Preemptive analgesia can decrease the sensitization of the central nervous system that would ordinarily amplify subsequent nociceptive input, but a clear demonstration of its clinical efficacy is necessary for it to become a routine component of acute pain therapy. OBJECTIVE.— To determine...

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Published in:JAMA : the journal of the American Medical Association Vol. 279; no. 14; pp. 1076 - 1082
Main Authors: Gottschalk, Allan, Smith, David S, Jobes, David R, Kennedy, Sean K, Lally, Sara E, Noble, Vicki E, Grugan, Kathy F, Seifert, Harry A, Cheung, Albert, Malkowicz, S. Bruce, Gutsche, Brett B, Wein, Alan J
Format: Journal Article
Language:English
Published: Chicago, IL American Medical Association 08-04-1998
Subjects:
Aged
Analgesia, Epidural
Analgesics
Analysis of Variance
Anesthesia, General
Biological and medical sciences
Bupivacaine
Double-Blind Method
Fentanyl
Humans
Male
Medical sciences
Middle Aged
Neuropharmacology
Pain
Pain Measurement
Pain, Postoperative - prevention & control
Pharmacology. Drug treatments
Prostate
Prostatectomy
Statistics, Nonparametric
Time Factors
Human
Postoperative
Chemotherapy
Urinary system disease
Treatment
Analgesic
Pain
Prostate disease
Surgery
Treatment efficiency
Extradural administration
Prostatectomy
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Summary:CONTEXT.— Preemptive analgesia can decrease the sensitization of the central nervous system that would ordinarily amplify subsequent nociceptive input, but a clear demonstration of its clinical efficacy is necessary for it to become a routine component of acute pain therapy. OBJECTIVE.— To determine the impact of preemptive epidural analgesia on postoperative pain and other clinically important outcome variables after radical retropubic prostatectomy. DESIGN AND SETTING.— A block randomized double-blind clinical trial lasting 20 months at a single academic medical center. PATIENTS.— A total of 100 generally healthy and neurologically intact patients scheduled for radical retropubic prostatectomy for the treatment of prostate cancer in whom an epidural catheter for treating postoperative pain was to be placed prior to the induction of general anesthesia. INTERVENTIONS.— Epidural bupivacaine, epidural fentanyl, or no epidural drug was administered prior to induction of anesthesia and throughout the entire operation, followed by aggressive postoperative epidural analgesia for all patients. MAIN OUTCOME MEASURES.— Daily pain scores during hospitalization and pain scores obtained 3.5, 5.5, and 9.5 weeks after hospital discharge. RESULTS.— The patients who received epidural fentanyl or bupivacaine prior to surgical incision (preemptive analgesia) experienced 33% less pain while hospitalized (P=.007). Pain scores in those receiving preemptive analgesia were significantly lower at 9.5 weeks (P=.02), but were not significantly different at 3.5 or 5.5 weeks. At 9.5 weeks, 32 (86%) of 37 patients receiving preemptive analgesia were pain-free compared with 9 (47%) of 19 control patients (P=.004). Patients receiving preemptive analgesia were more active 3.5 weeks after surgery (P=.01), but not at 5.5 or 9.5 weeks. CONCLUSIONS.— Even in the presence of aggressive postoperative pain management, preemptive epidural analgesia significantly decreases postoperative pain during hospitalization and long after discharge, and is associated with increased activity levels after discharge.
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ISSN:0098-7484
1538-3598
DOI:10.1001/jama.279.14.1076