• R Hering, T Schumacher, and H Müller.
• Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin, Rheinischen Friedrich-Wilhelms-Universität Bonn.
• Anasthesiol Intensivmed Notfallmed Schmerzther. 1996 Nov 1;31(9):550-5.

ObjectiveThe purpose of this study was to investigate whether continuous epidural administration of combined low dose local anaesthetic, opioid and clonidine can provide sufficient postoperative analgesia after major abdominal surgery.Methods45 patients (ASA I-III), scheduled for major abdominal surgery, were randomly divided into three groups. Prior to surgery all patients received an epidural catheter before induction of general anaesthesia. After 90 minutes a 10 ml bolus of the study solution was given via the epidural catheter followed by a continuous infusion of 5 ml/h until the end of surgery and further on 5-8 ml/h for 24 hours postoperatively. The solutions consisted of 50 micrograms sufentanil in 50 ml 0.125% bupivacaine (group 1), 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 2) and 50 micrograms sufentanil + 150 micrograms clonidine in 50 ml 0.125% bupivacaine (group 3). Measurements included the total dose of infused drug solution, pain at rest and on exercise by a visual analogue scale, cardiorespiratory data and side-effects within the first 24 hours postoperatively. A standardised interview on analgesia and side-effects was held two days after surgery.ResultsAt rest excellent analgesia could be provided by all of the tested drug solutions. On exercise we evaluated lower pain scores in group 3 (1.9 +/- 1.1) compared to group 1 (2.8 +/- 1.6) or group 2 (3.8 +/- 2.1) (2 vs 3 p < 0.05). Severe side effects such as respiratory depression or drop of heart rate or blood pressure did not occur.ConclusionsEpidural administration of drug solutions containing a low dose local anaesthetic, opioid and alpha 2-agonist, provides excellent analgesia after major abdominal surgery. Patients at rest can be treated very effectively with both a combination of only two or with all of the tested drugs. On exercise the mixture containing all analgesics was more efficient than the solutions with only two of the tested drugs. Severe side effects such as respiratory depression or cardiovascular instability were not seen.

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