A comparative study of techniques of postoperative analgesia following Caesarean section and lower abdominal surgery

Abstract

A double-blind, within-patient trial was carried out to compare intramuscular pethidine 100 mg, epidural pethidine 50 mg and epidural bupivacaine 25 mg for pain relief on the day after caesarean section or lower abdominal gynaecological surgery. Analgesia was assessed on a visual analogue pain scale. Forced expiratory volume in one second (FEV1.0) and venous plasma catecholamine levels were measured immediately before and approximately thirty minutes after each treatment. At the completion of the study the treatments were ranked in order of patient preference. Nineteen patients completed the trial. Analgesia provided by epidural pethidine 50 mg was superior to intramuscular pethidine 100 mg (p < 0.05) but not statistically better than epidural bupivacaine. There was no significant difference in the duration of analgesia between the active treatments. A mean increase in FEV1.0 of 18% occurred after both of the epidural treatments, but this did not achieve statistical significance. There was no significant change in catecholamine levels after any of the treatments. Epidural pethidine was preferred by patients over and above intramuscular pethidine and epidural bupivacaine (p < 0.05).