Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial

Background: Although pre-emptive analgesia is commonly used for the management of postoperative pain in developed countries, no defined protocol has been carried out and widely practiced, especially in transabdominal hysterectomy. Keeping this in mind the present study aimed to investigate the effects of multimodal pre-emptive analgesia on pain management, stress response and inflammatory factors of patients undergoing transabdominal hysterectomy to find an optimized way of pre-emptive analgesia. Methods: One hundred patients undergoing abdominal hysterectomy were randomly divided into four groups (Trial registration: ChiCTR-IPR-15005848). Group P1 was given intravenous flurbiprofen and epidural fentanyl + ketamine before surgery; Group P2 received intravenous flurbiprofen before surgery and epidural fentanyl + ketamine after surgery; Group P3 was given epidural fentanyl + ketamine before surgery and intravenous flurbiprofen after surgery; Patients in Group C received normal saline treatment. Results: Compared with control group, the first time to request additional analgesics after surgery were significantly later (P<0.05), 24 h dosage of analgesia were significantly less (P<0.05), VAS score at all time periods after surgery were significantly lower (P<0.05) in Group P1, P2, or P3. At 12 h or 24 h after surgery, VAS score in Group P1 was significantly lower than that in group P2 or P3 (P<0.05, P<0.05). No significant adverse effects were found among the groups (P>0.05). At 1 or 2 days after surgery, the levels of cortisol, glucose, and IL-6, TNF-alpha in group P1, P2, and P3 were significantly lower than those in group C (P<0.05); while, the levels in group P2, P3 were significantly lower than those in group P1 (P<0.05). Conclusion: Multimodal pre-emptive analgesia could significantly lower VAS score, inhibit stress response, and reduce inflammatory response in patients undergoing transabdominal hysterectomy, which can be a rational strategy for pain control in future.