Article Text

Download PDFPDF
Subarachnoid Opioid Analgesia Reduces Long-term Postsurgical Pain After Nephrectomy
  1. Kenneth H. Gwirtz, M.D.,
  2. Kirt A. Beckes, M.D.,
  3. Robert P. Maddock, M.D.,
  4. Gary L. Gettelfinger, M.D. and
  5. Wei Li, M.S.
  1. From the Department of Anesthesia, Indiana University School of Medicine, Indianapolis, Indiana
  1. Reprint requests: Kenneth H. Gwirtz, M.D., Department of Anesthesia, Indiana University School of Medicine, 1120 South Drive, Fesler Hall 204, Indianapolis, IN 46202-5115.


Background and Objectives. The initiation of pain has been shown to exaggerate and prolong the transmission of subsequent noxious stimuli through central sensitization of the spinal cord. It has been suggested that the prevention of acute postoperative pain may facilitate easier subsequent management and may also reduce long-term residual pain. The authors sought to examine whether patients receiving subarachnoid analgesia, administered at the completion of surgery but before awakening, experienced less postoperative pain within the first 12 months of surgery.

Methods. The charts of 27 postdonor nephrectomy patients were reviewed retrospectively. Nineteen were given subarachnoid analgesia and eight were given patient-controlled analgesia. All patients elected their method of postoperative analgesia at the time of surgery. Subarachnoid analgesia patients received either morphine alone, or morphine in combination with fentanyl, bupivacaine, or both. Most (13 out of 19) were given morphine (0.5-0.7 mg; mean, 0.59) plus 25 μg fentanyl and 3.75 mg bupivacaine. Two to twelve months after surgery, both groups were contacted by telephone and asked to answer a 10-question interview. Patients were asked to rate their current level of pain (verbal analog scale of 0-10) regarding severity, frequency, limitation of function, and continued need for oral analgesics.

Results. Donor nephrectomy patients receiving subarachnoid analgesia had significantly lower average pain scores with respect to intensity, frequency, and limitation of function up to 12 months after surgery (P < .05).

Conclusions. Management of acute postoperative pain with subarachnoid analgesia may confer lasting benefits by decreasing long-term residual pain, presumably by interfering with the process of central sensitization. The social and economic impact of intraspinal analgesia in reducing protracted postsurgical discomfort and debility deserves further study.

  • acute pain
  • subarachnoid analgesia
  • central sensitization
  • chronic pain
  • opioid

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.