Clinical studies on pre-emptive
analgesia have produced inconsistent results. We conducted a clinical study investigating the effect of long-lasting pre-emptive
epidural analgesia on consumption of
analgesics and
acute pain. Forty-two patients scheduled for elective hip replacement for osteo-
arthritis were randomly assigned to receive, on the day before operation, either 5 ml.h(-1)
ropivacaine 0.2% (study group, n = 21) or 5 ml.h(-1) saline (control group, n = 21). Postoperative
analgesia was achieved in both groups by patient-controlled
epidural analgesia (PCEA) with
ropivacaine 0.2%. The main outcome measure was consumption of local anaesthetics. Additional parameters included visual analogue
pain scale (VAS) scores, consumption of rescue
analgesics, requests for PCEA boluses, and side-effects. The pre-operative parameters and
pain scores were similar in the two groups. Epidural blocks provided sufficient operative
analgesia in all patients. Pre-emptive
analgesia was continued for 11-20 h and led to significantly decreased
pain scores before surgery. The consumption of local anaesthetics was decreased postoperatively in the study group (194 mg vs. 284 mg in the postoperative period). Furthermore, bolus requests occurred more frequently in the control group. VAS scores did not differ significantly between groups. Long-lasting "pre-emptive"
epidural analgesia decreases
postoperative pain with improved
pain control.