COMBINED SPINAL EPIDURAL FOR POST OPERATIVE ANAESTHESIA OF PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY: AN OBSERVATIONAL STUDY

Main Article Content

Dr. Sujeela Waheed
Dr. Sayema Javed Rana
Dr. Tantry Tariq Gani

Keywords

Abdominal   Hysterectomy, Epidural Anesthesia, Spinal Anaesthesia, Postoperative Pain, VAS, Ropivacaine

Abstract

Background: Postoperative pain management is a matter of concern for every anaesthesiologist. Effective pain management is now an integral part of modern surgical practice. Despite recognition of the importance of effective pain control, up to 70% of patients still complain of moderate to severe pain postoperatively.


Aim: The aim of the study was to assess the efficacy and safety of CSE Anaesthesia compared to spinal anaesthesia in patients undergoing hysterectomy.


METHODS: Sixty female patients scheduled for an elective total abdominal hysterectomy were prospectively randomized in to two groups, Group A (n = 30) received 0.2% Ropivacaine bolus dose  through epidural at the time of shifting to post operative ward and  Group B (n = 30) received i.v analgesics in the form of paracetamol and tramadal. Data collected on a predesigned data collection sheet included patient’s demographics, postoperative analgesia modality, patient satisfaction, acute pain service assessment of visual analog scale  (VAS), number of breakthrough pains, number of rescue boluses, time required for the pain relief after rescue analgesia, and any complication for 48 h.


RESULTS: Low VAS scores were observed in the epidural  Group at all times compared with the  Group B (P< 0.05) except at 24 hrs where the difference was not significant ( P=0.124). Time to recue analgesic was longer in Group A compared to Group B, the difference was statistically significant ( P=0.003).Total rescue analgesia consumption was lowest in Group A than Group B , the difference was statistically significant.(P < 0.05). Postoperative side effects like nausea, vomiting, pruritis, hypotension were seen in both groups however the difference was statistically not significant (P>0.05).


CONCLSIONS: The effect of anesthetic and postoperative analgesic techniques on perioperative outcome varies with the type of operation performed. Overall, epidural analgesia provides better postoperative pain relief. Epidural anesthesia and epidural analgesia improve the overall outcome and shorten the hospital stay time in patients undergoing abdominal   hysterectomy.

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