Postoperative Pain Management with Epidural Anesthesia for Gynecologic Surgery

Kim, Ae Ra; Cheun, Jae Kyu

Abstract

Epidural anesthesia has been greatly substitued for spinal anetshesia because epidural aneshtesia can eliminate the most common and agonizing problems of headache and other neurologic sequelae resulting from spinal anesthesia. Many anesthetists are reluctant to give spinal anetshesia to the patients for gynecologic surgery because of the high incidence of postspinal headache in the middle age group of women. On the contrary, epidural anesthesia provides several advantages compared to spinal anetshesia such as eliminating complications of dural puncture and easy management of postoperative pain control. This investigation was primarily undertaken to observe the effectiveness of epidural anesthesia as well as postoperative pain controllability in gynecologic surgery. Out of total 526 cases who had gynecologic surgery, We had 275 cases (53%) who received epidural anesthesia during the last year. 2% lidocaine 400-500 mg, with 4 mg of morphine were used epidurally for total abdominal hysterectomies, ovarian cystectomies, and some cases of tuboplasty, and 2% lidocaine 300-400 mg, with 3 mg of morphine was used for vaginal hysterectomies. Continuous epidural anesthesia in association with general anesthesia was used for tubal anastomosis and radical hysterectomy, and 4 mg morphine was given through the catheter at the end of surgery. The results are as follows: 1) The duration of postoperative analgesic effect was 21.1+/-5.5 hours. 2) The adverse effects from epidural morphine administration showed 42 (15%) patients had nausea and/or vomiting and 58 (21%) patients had itching. 3) Complications of epidural anesthesia were dural puncture-4 cases (1.4%), convulsion-1 case (0.3%), backache-48 cases (17%), and hypotension-44 cases (16%). The results of this study suggest that epidural anesthesia with 3-4 mg of epidural morphine can be satisfactory for gynecologic surgery and postoperative pain control.