Optimal Multimodal Analgesia in Abdominal Hysterectomy

The purpose of this study is to test the current standard of care (SOC) treatment for abdominal hysterectomy with a group receiving SOC minus epidural analgesia plus additional perioperative analgesics in terms of postoperative abilities, postoperative nausea and vomiting (PONV), pain and discharge time from the PACU (post-anaesthesia care unit).

Aim of the study: to compare postoperative complaints (PONV, pain, etc) and PACU discharge time between two groups, for patients admitted for planned abdominal hysterectomy with or without BSO:

• A: standard of care (SOC) receiving paracetamol, celecoxib, epidural analgesia, dexamethasone, ondansetron and droperidol, and general anaesthesia with propofol, remifentanil and cisatracurium
• B: SOC with sham epidural analgesia, preoperative gabapentin, intraoperative lidocaine, s-ketamine and sufentanil

Inclusion Criteria:

• Planned abdominal hysterectomy with or without BSO
• Age above 18 years
• Written informed consent
• American Society of Anesthesiologists (ASA) class I-III

Exclusion Criteria:

• Planned vaginal or laparoscopic hysterectomy
• Hysterectomy as part of other surgery
• Allergy to part of the treatment regimen
• Previous reactions to opioids (nausea, cognition)
• Previous inability to place correct epidural catheter
• Severe state anxiety according to the OCAP or STAI
• ASA class IV
• Dependency on alcohol, opioids or central stimulants
• Chronic pain condition
• Hemorrhagic diathesis
• Participation in another study