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Anesth Analg 1988; 67:737-740
© 1988 International Anesthesia Research Society
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The Roles of Acute and Chronic Pain in Regression of Sensory Analgesia During Continuous Epidural Bupivacaine Infusion

Torben Mogensen, MD, Nicholas B. Scott, FRCS (Ed), Claw Lund, MD, Dennis Bigler, MD, Nils-Christian Hjortsø, MD, and Henrik Kehlet, MD, PhD

Received from the Departments of Anesthesiology and Surgical Gatroenterology, Hvidovre University Hospital, Copenhagen, Denmark.

Abstract

The purpose of this study was to investigate whether regression of sensory analgesia during constant epidural bipuvacaine infusion was different in postoperative patients with acute pain than in patients with chronic nonsurgical pain. Sensory levels of analgesia (to pinprick) and pain (on a five-point scale) were assessed hourly for 16 hours during continuous epidural infusion of 0.5% plain bupivacaine (8 ml/hr) in 12 patients with chronic nonsurgical pain and in 30 patients after major abdominal surgery performed under combined bupivacaine and halothane—N2O general anesthesia. No opiates were given. If sensory analgesia decreased more than five segments from the initial level or if the pain score reached 2 (moderate pain), the patient was removed from the study. Initial levels of sensory analgesia after loading doses of 21.8 ± 0.5 and 19.3 ± 0.8 ml bupivacaine 0.5% were similar (T3.8 ± 0.3, and T3.8 ± 0.5) in the surgical and chronic pain patients, respectively (mean ± SEM). Of the surgical patients, only 4 of the 30 (13%) maintained the initial level of sensory analgesia, and a pain score below 2 throughout the study compared with 7 of the 12 patients with chronic pain (58%) (P < 0.01). Mean duration of sensory blockade was significantly longer (P < 0.005) in the patients with chronic pain than in surgical patients (13.1 ± 1.2 and 8.5 ± 0.7 hours, respectively). Thus, surgical injury hastens regression of sensory analgesia during continuous epidural bupivacaine infusion. The underlying mechanism remains to be determined.

Key Words: PAIN, CHRONIC—postoperative • ANESTHETIC TECHNIQUES, EPIDURAL—bupivacaine






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1988 by the International Anesthesia Research Society.