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Correspondence  |   July 2003
Pain Significantly Influences Postoperative Wound Oxygen Tension
Author Affiliations & Notes
  • Donal Buggy, M.D., M.Sc.
    *
  • *Mater Misericordiae Hospital, Dublin, Ireland.
Article Information
Correspondence
Correspondence   |   July 2003
Pain Significantly Influences Postoperative Wound Oxygen Tension
Anesthesiology 7 2003, Vol.99, 238. doi:
Anesthesiology 7 2003, Vol.99, 238. doi:
In Reply:—
We thank Dr. Hübler for his interest in our manuscript, but we think he may have missed the point. Our stated hypothesis was to evaluate whether combined general anesthesia and epidural anesthesia and postoperative analgesia would increase subcutaneous tissue oxygen tension in the wound (PsqO2) compared with general anesthesia alone followed by postoperative opioid analgesia. It is well recognized that epidural analgesia provides superior analgesia compared with intravenous morphine analgesia, and as Dr. Hübler points out, minimizing pain increases PsqO2. Therefore, of course  our patients with epidural analgesia had less pain: The issue we evaluated was whether the method  of analgesia (epidural or intravenously administered opioid) also influences PsqO2. Furthermore, randomization took place preoperatively, and the distinction between our two groups commenced before the induction of anesthesia, not on emergence.
We believe Dr. Hübler's proposed repeat study is unworkable, because postoperative patients on intravenously administered opioid patient-controlled analgesia can never realistically expect to achieve similar levels of analgesia after major laparotomy compared with functional epidural analgesia.