Regular interval preventive pain relief compared with on demand treatment after hysterectomy

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Abstract
Otherwise healthy women (80) aged 22-64 yr, admitted for elective hysterectomy were studied in a prospective randomized trial. Two different postoperative pain relief schedules, one with the analgesic given at regular intervals and the other with the analgesic given on demand were compared. All the patients had a neuroleptanesthesia with fentanyl. Half received an initial dose of buprenorphine 0.3 mg i.v. before termination of anesthesia and continued with sublingual buprenorphine 0.4 mg every 6 h postoperatively (regular interval (RI) group). The other half received the standard postoperative medication, mepridine 1 mg/kg on demand in the recovery room, followed by ketobemidone 4 mg s.c. on demand in the surgicl ward (on demand (OD) group). There was no difference between groups concerning pain relief following a single dose of analgesic (P < 0.05, type II error 1-5%). In the recovery room 17.5% of the patients in the RI group received an analgesic compared to 87.5% in the OD group (P < 0.05). Among patients in the RI group who had previously got injections for postoperative pain relief on demand 95% preferred regular interval sublingual buprenorphine for future treatment. The nurses found that 90% of the patients in the RI group were treated adequately compared to 62.5% of the patients in the OD group (P < 0.05). Regular interval preventive pain relif is superior to conventional on demand analgesic therapy in postoperative pain.