Authors
1 Anesthesia Department, Medicine Faculty, Semnan University of Medical Sciences, Semnan, Iran
2 Midwifery Department, Medicine Faculty, Semnan Branch, Islamic Azad University, Semnan, Iran
3 Gynecology Department, Medicine Faculty, Iran University of Medical Sciences, Tehran, Iran
4 Internal Medicine Department, Medicine Faculty, Semnan University of Medical Sciences, Semnan, Iran
5 Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
Abstract
Aims: Owing to the effects of anesthesia on pain after hysterectomy as well as different advantages and disadvantages of spinal anesthesia (SA) and general anesthesia (GA), giving priority to one of these techniques over the other still seems controversial. The aim of the present study was to compare SA with GA in terms of pain intensity, the frequency of nausea and vomiting and morphine requirements after abdominal hysterectomy.
Instruments and Methods: This double-blind clinical trial was conducted on 40 abdominal hysterectomy candidates with American Society of Anesthesiologists I and II presenting to Kowsar Hospital, Semnan, Iran, in 2015. All the patients were briefed on the pain assessment scale the day before the surgery, randomly divided into two groups of GA and SA and underwent abdominal hysterectomy using the same technique. Postoperative pain was then recorded upon admission to post-anesthesia care unit and 6 and 12h later. Furthermore, frequency of nausea and vomiting as well as intravenous morphine requirements was recorded within the first 12h after the surgery. Data were analyzed using independent t-test and Chi-square by SPSS 16 software.
Findings: Postoperative pain was found to be significantly lower upon entering PACU and 6 and 12h later in the SA group compared to that in the GA group, as was the case for the frequency of nausea and vomiting as well as the dose of intramuscular morphine (p<0.05).
Conclusion: Generally, postoperative pain in SA is lower than in GA, although different postoperative complications such as nausea and vomiting are observed.
Keywords
- Eriksson LI. Miller's Anesthesia. Miller RD, Eriksson LI, editors. Amsterdam: Elsevier; 2009.
- Sun Y, Li T, Wang N, Yun Y, Gan TJ. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: A meta-analysis of randomized controlled trials. Dis Colon Rectum. 2012;55(11):1183-94. [DOI:10.1097/DCR.0b013e318259bcd8] [PMID]
- Gandhi K, Heitz JW, Viscusi ER. Challenges in acute pain management. Anesthesiol Clin. 2011;29(2):291-309. [DOI:10.1016/j.anclin.2011.04.009] [PMID]
- Reuben SS, Ekman EF. The effect of initiating a preventive multimodal analgesic regimen on long-term patient outcomes for outpatient anterior cruciate ligament reconstruction surgery. Anesth Analg. 2007;105(1):228-32. [DOI:10.1213/01.ane.0000265443.20919.c8] [PMID]
- Safaeian R. Comparison between incidence of postoperative nausea and vomiting after total abdominal hysterectomy in general and epidural anesthesia. Razi J Med Sci. 2001;8(25):308-11. [Persian]
- Kavanagh T, Buggy DJ. Can anaesthetic technique effect postoperative outcome?. Curr Opin Anaesthesiol. 2012;25(2):185-98. [DOI:10.1097/ACO.0b013e32834f6c4c] [PMID]
- Kessous R, Weintraub AY, Wiznitzer A, Zlotnik A, Pariente G, Polachek H, et al. Spinal versus general anesthesia in cesarean sections: The effects on postoperative pain perception. Arch Gynecol Obstet. 2012;286(1):75-9. [DOI:10.1007/s00404-012-2265-y] [PMID]
- Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS. Risk factors for chronic pain after hysterectomy: A nationwide questionnaire and database study. Anesthesiology. 2007;106(5):1003-12. [DOI:10.1097/01.anes.0000265161.39932.e8] [PMID]
- Naghibi K, Saryazdi H, Kashefi P, Rohani F. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study. J Res Med Sci. 2013;18(7):543-8.
- Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial. J Res Med Sci. 2011;16(4):524-9.
- Borendal Wodlin N, Nilsson L, Kjølhede P, GASPI study group. The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: A randomised clinical trial. BJOG. 2011;118(3):299-308. [DOI:10.1111/j.1471-0528.2010.02697.x] [PMID]
- Rebel A, Sloan P, Andrykowski M. Retrospective analysis of high-dose intrathecal morphine for analgesia after pelvic surgery. Pain Res Manag. 2011;16(1):19-26. [DOI:10.1155/2011/691712] [PMID]
- Kunstman JW, Udelsman R. Superiority of minimally invasive parathyroidectomy. Adv Surg. 2012;46(1):171-89. [DOI:10.1016/j.yasu.2012.04.004] [PMID]
- Borendal Wodlin N, Nilsson L, Carlsson P, Kjølhede P. Cost-effectiveness of general anesthesia vs spinal anesthesia in fast-track abdominal benign hysterectomy. Am J Obstet Gynecol. 2011;205(4):326,e1-7. [DOI:10.1016/j.ajog.2011.05.043] [PMID]
- Heidari SM, Mirlohi SZ, Hashemi SJ. Comparison of the preventive analgesic effect of rectal ketamine and rectal acetaminophen after pediatric tonsillectomy. Int J Prev Med. 2012;3(Suppl 1):S150-5.
- Safavi M, Honarmand A, Habibabady MR, Baraty S, Aghadavoudi O. Assessing intravenous ketamine and intravenous dexamethasone separately and in combination for early oral intake, vomiting and postoperative pain relief in children following tonsillectomy. Med Arh. 2012;66(2):111-5. [DOI:10.5455/medarh.2012.66.111-115] [PMID]
- Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal vs general anesthesia for laparoscopic cholecystectomy: Interim analysis of a controlled randomized trial. Arch Surg. 2008;143(5):497-501. [DOI:10.1001/archsurg.143.5.497] [PMID]
- Gonano C, Leitgeb U, Sitzwohl C, Ihra G, Weinstabl C, Kettner SC. Spinal versus general anesthesia for orthopedic surgery: Anesthesia drug and supply costs. Anesth Analg. 2006;102(2):524-9. [DOI:10.1213/01.ane.0000194292.81614.c6] [PMID]
- Imbelloni LE, Fornasari M, Fialho JC, Sant'Anna R, Cordeiro JA. General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy. Rev Bras Anestesiol. 2010;60(3):217-27. [DOI:10.1016/S0034-7094(10)70030-1]
- Massicotte L, Chalaoui KD, Beaulieu D, Roy JD, Bissonnette F. Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy. Acta Anaesthesiol Scand. 2009;53(5):641-7. [DOI:10.1111/j.1399-6576.2009.01930.x] [PMID]
- Catro-Alves LJ, De Azevedo VL, De Freitas Braga TF, Goncalves AC, De Oliveira GS Jr. The effect of neuraxial versus general anesthesia techniques on postoperative quality of recovery and analgesia after abdominal hysterectomy: A prospective, randomized, controlled trial. Anesth Analg. 2011;113(6):1480-6. [DOI:10.1213/ANE.0b013e3182334d8b] [PMID]
- Wodlin NB, Nilsson L, Arestedt K, Kjølhede P, 'GASPI' Study Group. Mode of anesthesia and postoperative symptoms following abdominal hysterectomy in a fast-track setting. Acta Obstet Gynecol Scand. 2011;90(4):369-79. [DOI:10.1111/j.1600-0412.2010.01059.x] [PMID]
- Shohani M, Rasoli M, Maleki F. Comparison study of pain after cesarean section by general and spinal anesthesia. J Ilam Univ Med Sci. 2013;21(3):30-8. [Persian]
- Roodneshin F, Kamranmanesh MR. Opioid-Sparing effect of spinal vs general anesthesia on postoperative analgesia in percutaneous nephrolithotripsy: A randomized clinical trial. J Iran Soc Anesthesiol Crit Care. 2014;35(85):1-9. [Persian]
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