Effects Of Epidural Fentanyl And Lidocaine For Visceral Pain And Stress During Pelvic Operation

Although continuous epidural anesthesia can provide complete cutaneous sensation block, it can' t block the visceral pain completely during operation because of the character of the distribution of visceral sensory nerve. Patients usually complain varietal visceral pain and maybe stir up serious stress.Epidural administration of fentanyl selectively blocks nociceptive transmission at the spinal opiate reporters. It can enhance the effect of epidural anesthesia and improves the onset of epidural local anesthetic effectively. But the data of effects of combined use epidural fentanyl and lidocaine for visceral pain and stress during operation are limited. So a double-blind randomised controlled experiment was designed to determine the effects of epidural fentanyl and lidocaine for visceral pain and stress during pelvic operation.MethodsTwenty five elective patients scheduled for abdominal subtotal hysterectomy (30 ~ 50 years old, ASA physical status I ~ H ) were allocated randomly in a double-blind fashion to receive 2% lidocaine 18ml plus fentanyl 0. lmg (experiment group,n = 13) or 2% lidocaine 18ml plus Saline 2ml( control group, n = 12). The concentration of lidocaine is 1. 8% and do not contain adrenaline in both group. No patients were taken any premedication. The standard of visceral pain was evaluated as follow: Class 0, patient calm and hasn' t any discomfort. Class I , slight discomfort. Class II , light visceral pain but not vomit. Class III, visceral pain obviously and accompany with nausea, vomiting, and meteor-ism. ECG, NIBP and SpO2 were monitored and recorded continuously during theoperation. Peripheral venous blood samples were taken before surgery; at 60 and 90 minute after incision. The blood sugar was measured. Blood serum was dissociated and frozen at -75C until assay. A radioimmunoassay was used to determine serum cortisol and insulin levels.ResultsBoth groups of patients were comparable with respect to patient age, weight, duration of operation and the consumption of lidocaine. Cutaneous sensation was blocked completely for all patients in both groups. Only one patient (7. 69% ) felt light visceral pain (Class II ) in the experiment group compared with 7 patients (58. 33%) felt varietal degree of visceral pain in the control group (Class II ~ III) The total consumption of intraoperative pethidine was 50 mg in the experiment group and 420mg in the control group. The incidence of visceral pain and the consumption of intraoperative pethidine were significantly lower in experiment group than in control group (P <0.05).Mean arterial pressure ( MAP) of the experiment group was significantly lower during peritoneum incision and exploration than the basis. The mean reduction level was 10.56% and 10. 80% ( p <0.05). MAP of the control group was significantly lower during exploration and conclusion of the operation than the basis. The mean reduction degree was 19. 52% (p < 0.01) and 14.45% ( p < 0. 05). The heart rate of experiment group was more stable than that of control group.There was no difference in the concentration of serum cortisol, insulin and blood sugar before operation between the two groups. The concentration of serum cortisol and blood sugar had no significantly change at 60 and 90 minute after incision in the experiment group(P >0.05) but significantly increased in the control group (p < 0. 01). The concentration of serum insulin had some decrease in both groups but had no statistics difference, the range in control group was more serious than in experiment group(P <0.05).ConclusionThe combined use of fentanyl and lidocaine for continuous epidural anesthesia can provide efficient visceral pain relief and relatively stable hemodynamics, can efficiently attenuate the increase of serum cortisol and blood sugar and insulin resistance associate with stress.