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PAIN MEDICINE

Prolonged Differential Wound Hyperalgesia After an Interval of Unilateral Epidural Blockade During Lower Abdominal Surgery

Allan Gottschalk, MD, PhD^*, and Steven M. Frank, MD

*Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland; and Department of Anesthesiology, Greater Baltimore Medical Center, Towson, Maryland

Address correspondence and reprint requests to Allan Gottschalk, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Meyer 8-134, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-4965. Address e-mail to agottschalk{at}jhmi.edu.

We assessed postoperative pain at rest and with movement along with wound hyperalgesia in a patient who had undergone lower abdominal surgery under general anesthesia with a unilateral epidural block that persisted throughout surgery and in whom the epidural catheter was replaced immediately afterward. Pain and wound hyperalgesia were consistently greater on the "unblocked" side for the 3-wk period of observation. Thus, even imperfect intraoperative attenuation of noxious stimuli can lead to persistent reductions in postoperative pain.