Main Article Content

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


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


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.

Abstract 49 | pdf Downloads 18


1. Melo MCB, Barros ÉND. Histerectomia e simbolismo do útero:possíveis repercussões na sexualidade feminina. Rev SBPH.2009;12:80---99.
2. Lee WK, Kim MS, Kang SW, Kim MS, Lee JR. Type of anaesthesiaand patient quality of recovery: a randomized trial compar-ing propofol-remifentanil total i.v. anaesthesia with desfluraneanaesthesia. Br J Anaesth. 2015;114:663---8.
3. Poitras S, Beaule P, Dervin GF. Validity of a short-term qualityof life questionnaire in patients undergoing joint replacement:the Quality of Recovery-40. J Arthroplasty. 2012;27:1604---8.
4. Kluivers KB, Riphagen I, Vierhout ME, Brölmann HA, de Vet HC.Systematic review on recovery specific quality-of-life instru-ments. Surgery. 2008;143:206---15.
5. Murphy GS, Szokol J, Greenberg SB, et al. Preoperative dex-amethasone enhances quality of recovery after laparoscopiccholecystectomy: effect on in-hospital and postdischarge recov-ery. Anesthesiology. 2011;114:882---90.
6. Estivalet FF, Bagatini A, Gomes CR. Remifentanil associated topropofol or sevoflurane for videolaparoscopic cholecystectomy:a comparative study. Rev Bras Anestesiol. 2002;52:385---93.
7. Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth 2002;89:409‑23.
8. Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post‑surgical pain: Results from a US national survey. Curr Med Res Opin 2014;30:149‑60.
9. Cook TM. Combined spinal-epidural techniques. Anaesth 2000;55:42-64.
10. Eldor J. Combined spinal epidural general anaesthesia. Reg Anaesth 1994;19:365-366.
11. Rajan S, Seetharaman M, Nair SG. Comparison of efficacy and safety of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients. Amrita J Anaesth 2014;1-44.
12. Fan S-Z,Susetio I, Wan Gyp, Low dose of intrathecal hyperbaric bupivacaine combined with epidural lidocaine for caesarean section – a balance block technique. Anaesth Analg 1994;78:474-477.
13. Hamdani GA, Chohan U, Zubair NA. Clinical usefulness of sequential combined spinal epidural anaesthesia in high risk geriatric patients for major orthopaedic surgery. J Anesth Clin Pharmacol 2002;18(2):163.
14. Blumgart CH, Ryall D, Dennison B, Thompson Hill LM. Mechanism of extension of spinal anaesthesia by extradural injection of local anaesthetic. Br J Anaesth 1992;69:457-460.
15. Bhattacharya D, Tewari I, Chowdhuri S. Comparative study of sequential combined spinal epidural anaesthesia versus spinal anaesthesia in high risk geriatric patients for major orthopaedic surgery. Indian J Anaesth 2007;51(1):32-36.
16. Mercadante S, Villari P, Casuccio A, Marrazzo A. A randomized-controlled study of intrathecal versus epidural thoracic analgesia in patients undergoing abdominal cancer surgery. Journal of clinical monitoring and computing. 2008;22(4):293-8.
17. Glise H. Abrahamsson H. Spino-vagal nonadrenergic inhibition of gastric motility elicited by abdominal nociceptive stimulation in the cat. ScandJ Gostroenterol 1980; 15: 665-72.
18. Mclndoe AK, Warwick P. O'Connor M. A comparison of retrospective versus contemporaneous nausea scores with patientcontrolled analgesia (see comments). Anaesthesia 1996; 5 I : 333-7.
19. Warriner CB, Knox D, Belo S, Cole C, Finegan BA, Perreault I. Prophylactic oral dolasetron mesylate reduces nausea and vomiting after abdominal hysterectomy. The Canadian Dolasetron Study Group. Con J Anaesth 1997; 44: I 167-73.
20. Asantila R, Eklund P, Rosenberg PH. Continuous epidural infusion of bupivacaine and morphine for postoperative analgesia after hysterectomy. Acta Anaesthesiol Scond I99 I ; 35: 5 13-1 7.
21. Cruickshank RH, Spencer A, Ellis FR. Pretreatment with controlledrelease morphine for pain after hysterectomy. Anaesthesia 1996;51:1091.101.
22. Thorn SE, Wattwil M. Naslund I. Postoperative epidural morphine, but not epidural bupivacaine, delays gastric emptying on the first day after cholecystectomy. Reg Anesth 1992; I 7: 9 I.
23. Scheinin B, Asantila R, Orko R. The effect of bupivacaine and morphine on pain and bowel function after colonic surgery. Acto Anoesthesiol Scand 1987; 3 I : I 6 1-4.
24. Scott DA, Chamley DM, Mooney PH, Deam RK, Mark AH, Hagglof B. Epidural ropivacaine infusion for postoperative analgesia after major lower abdominal surgery-a dose finding study. Anesth Anolg 1995; 8 I : 982-6.
25. Schug SA, Scott DA. Payne J, Mooney PH. Hagglof B. Postoperative analgesia by continuous extradural infusion of ropivacaine after upper abdominal surgery. Br J Anaesth 1996; 76: 487-9 I.
26. Badner NH. Reid D, Sullivan P, et ol. Continuous epidural infusion of ropivacaine for the prevention of postoperative pain after major orthopaedic surgery: a dose-finding study. Con J Anaesth 1995; 8 I : 982-6.
27. Turner G, Blake D, Buckland M, et ol. Continuous extradural infusion of ropivacaine for prevention of postoperative pain after major orthopaedic surgery. Br j Anoesth 1996; 76: 606-1 0
28. Scott DA, Emanuelsson BM, Mooney PH, Cook RJ, Junestrand C. Pharmacokinetics and efficacy of long-term epidural ropivacaine infusion for postoperative analgesia (in process citation). Anesth Anolg 1997; 85: 1322-30.
29. Etches RC. Writer WD, Ansley D, et al. Continuous epiduralropivacaine 0.2% for analgesia after lower abdominal surgery. Anesth Anolg 1997; 84: 784-90.