Table 2 CEA protocols for group B (standard protocol) and group R (experimental protocol)

premedication

1 g oral paracetamol.

20 mg oral slow release oxycodone and

1 g oral paracetamol.

CEA/analgesia solution

Bupivacain 1 mg/ml, Epinephrine 2 μg/ml, and Fentanyl 2 μg/ml.

Ropivacain 2 mg/ml, combined with 20 mg oral slow release oxycodone with 12 hours interval.

Test dose before wound closure

2 ml bupivacain 5 mg/ml with epinephrine 5 μg/ml.

2 ml ropivacain 5 mg/ml with epinephrine 5 μg/ml.

If no adverse reaction was seen during a few minutes another dose of 5 to 7 ml was given.

CEA dosage

Initial dose 4 to 6 ml per hour combined with patient administered bolus doses of 2 ml with a maximum of 3 boluses per hour.

The slow release oxycodone was continued twice a day.

Duration of CEA

72 hours, transition to oral slow release oxycodone 20 mg twice a day.

72 hours, while the oral slow release oxycodone treatment was continued.

Pain breakthrough rescue treatment

Boluses of 2-6 ml were given and/or the epidural catheter was manipulated if indicated.

If the initial treatment would fail CEA was exchanged to bupivacain-only combined with patient controlled intravenous opiate, morphine or ketobemidone.

If this initial treatment would fail extra oral oxycodone or intravenous opiates, morphine or ketobemidone, may be added. If also this would fail patient controlled intravenous opiates was applied.