Optimal regional anaesthesia for abdominal hysterectomy: combined subarachnoid and epidural block compared with other regional techniques.

Regional anaesthesia for abdominal hysterectomy is commonly combined with heavy sedation or light general anaesthesia in order to avoid the occurrence of visceral pain. Our clinical experience has indicated that this pain can be controlled using regional anaesthesia techniques alone. In an effort to find the optimal technique, we randomly assigned 200 ASA and I and II patients who requested regional anaesthesia for abdominal hysterectomy (with or without elective appendicectomy) to one of five groups: 1) subarachnoid bupivacaine; 2) subarachnoid bupivacaine plus intravenous midazolam and buprenorphine; 3) epidural bipivacaine; 4) epidural bupivacaine plus epidural morphine; 5) subarachnoid bupivacaine plus epidural morphine and bupivacaine. The last combination provided by far the best analgesia. Only two of 40 patients complained of slight discomfort, and this was easily controlled. Success rates correlated also with the height of the blockade. It was concluded that the combination of subarachnoid bupivacaine plus epidural morphine and bupivacaine represents an effective and reliable technique for abdominal hysterectomy with or without elective appendicectomy.