Pain relief and functional status after vaginal hysterectomy: intrathecalversus general anesthesia

  • Juraj Sprung
  • Malcolm S. Sanders
  • Mary Ellen Warner
  • John B. Gebhart
  • C. Robert Stanhope
  • Christopher J. Jankowski
  • Lavonne Liedl
  • Darrell R. Schroeder
  • Daniel R. Brown
  • David O. Warner
Regional Anesthesia and Pain



We tested the hypothesis that the use of subarachnoid block (SAB) for vaginal hysterectomy produces superior postoperative analgesia and improves functional status at 12 weeks postoperatively.


In this randomized controlled trial 89 patients received either standardized general anesthesia vs SAB with bupivacaine, clonidine, and morphine. Postoperatively, patients in both groups received multimodal pain management. Primary outcomes included evaluation of pain and functional status (SF-36 Health Survey) over the 12 postoperative weeks.


Pain was well controlled throughout the study, as judged from the average pain numerical scale scores of ≤ 3 in both groups, at all times studied. Intrathecal analgesia lessened pain and decreased the use of morphine both in the postanesthesia care unit (PACU) and over the first 12 hr after discharge from the PACU (P < 0.001). Although patients who received SAB had a lower frequency of postoperative nausea in the PACU than the patients in the general anesthesia group (P = 0.021), this effect was not extended beyond the PACU stay. Subarachnoid block did not affect the length of hospitalization. At the two-week follow-up 69% of patients in the SAB group and 48% patients in the general anesthesia group were pain free (P = 0.044). At all evaluation intervals patients’ functional status was comparable between the SAB and general anesthesia group.


A significantly better immediate postoperative analgesia was present in the SAB group, and the duration was consistent with the expected action of intrathecally administered drugs. Tw o weeks after surgery a higher percentage of the patients in the SAB group reported no pain. However, SAB had no effect on either length of hospitalization or patients’ postoperative functional status.


Morphine Bupivacaine Epidural Analgesia Regional Anesthesia Vaginal Hysterectomy 
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Le contrôle de la douleur et l’état fonctionnel après l’hystérectomie vaginale: l’anesthésie intrathécale versus l’anesthésie générale



Nous avons vérifié l’hypothèse voulant que l’usage d’un block sous-arachnoïdien (BSA) pour l’hystérectomie vaginale produise une analgésie postopératoire supérieure et améliore l’état fonctionnel jusqu’à 12 semaines après l’opération.


Ľétude randomisée et contrôlée a porté sur 89 patientes qui ont reçu une anesthésie générale normalisée ou un BSA avec de la bupivacaïne, de la clonidine et de la morphine. Après l’opération, toutes les patientes ont reçu un traitement de la douleur multimodal. La douleur et l’état fonctionnel (SF-36 Health Survey) ont été notés pendant 12 semaines postopératoires.


La douleur a été bien contrôlée tout au long de l’étude, si l’on en juge par les scores moyens à l’échelle de douleur numérique ≤ 3 dans les deux groupes pour toutes les mesures prises. Ľanalgésie intrathécale a réduit la douleur et diminué l’usage de morphine à la salle de réveil (SDR) et pendant les 12 premières heures après le départ de la SDR (P < 0,001). Les patientes du groupe BSA ont eu moins de nausées postopératoires en SDR que les patientes sous anesthésie générale (AG), (P = 0,021), mais cet effet ne s’est pas prolongé au delà du séjour en SDR. Le BSA n’a pas permis d’écourter l’hospitalisation. Lors de l’examen de contrôle à la deuxième semaine, 69% des patientes du groupe BSA et 48% du groupe d’AG n’avaient plus de douleur (P= 0,044). Pendant toute l’étude, l’état fonctionnel a été comparable entre les groupes.


Une analgésie postopératoire immédiate significativement meilleure a été notée avec le BSA et de durée conforme à l’action attendue des médicaments intrathécaux administrés. Deux semaines après l’opération, un plus fort pourcentage de patientes du groupe BSA était sans douleur. Le BSA n’a cependant pas modifié la durée de l’hospitalisation ou l’état fonctionnel postopératoire des patientes.


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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Juraj Sprung
    • 1
  • Malcolm S. Sanders
    • 1
  • Mary Ellen Warner
    • 1
  • John B. Gebhart
    • 1
  • C. Robert Stanhope
    • 1
  • Christopher J. Jankowski
    • 1
  • Lavonne Liedl
    • 1
  • Darrell R. Schroeder
    • 1
  • Daniel R. Brown
    • 1
  • David O. Warner
    • 1
  1. 1.Department of AnesthesiologyMayo Clinic College of Medicine, Anesthesia Clinical Research Unit, Mayo ClinicRochesterUSA

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