Bupivacaine infusion above or below the fascia for postoperative pain treatment after abdominal hysterectomy.

Abstract:

BACKGROUND:We evaluated in which anatomic layer (above the fascia [AF] or below the fascia [BF]) wound infusion of bupivacaine has the best effect on postoperative pain after abdominal hysterectomy. METHODS:Sixty-two ASA physical status I and II patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy were enrolled into this prospective randomized, double-blind study. A standard general anesthetic was administered. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above (group AF, n = 29) or below (group BF, n = 31) the superficial abdominal fascia and 0.25% bupivacaine was administered via a patient-controlled analgesia device, programmed to deliver 9.0 mL with a 60-min lockout interval for 24 h. During the first 6 h after surgery, rescue i.v. fentanyl (25 microg) was administered to achieve a visual analog scale score of <4 cm. Total bupivacaine consumption, total rescue fentanyl consumption, pain scores (with resting, coughing, and leg raising), and patient satisfaction scores were compared in both groups. RESULTS:Total bupivacaine consumption over 24 h was significantly lower in group AF rather than group BF (90 +/- 26 mL vs 104 +/- 28 mL, respectively, P < 0.05). The total fentanyl consumption during the first 6 h after surgery was 109 +/- 59 microg in group AF and 166 +/- 70 microg in group BF (P < 0.01). Pain scores were lower in group AF at rest and coughing for the first 5 h and for the first 12 h with leg raise (P < 0.05 for all measurements). Thirteen patients (68%) in group AF defined their satisfaction as excellent whereas six patients (32%) in group BF defined their satisfaction as excellent (P = 0.034). CONCLUSION:We conclude that bupivacaine wound infusion AF provides better postoperative analgesia compared with infusion BF in the first 12 h after abdominal hysterectomy.

journal_name

Anesth Analg

journal_title

Anesthesia and analgesia

authors

Hafizoglu MC,Katircioglu K,Ozkalkanli MY,Savaci S

doi

10.1213/ane.0b013e318187ed23

subject

Has Abstract

pub_date

2008-12-01 00:00:00

pages

2068-72

issue

6

eissn

0003-2999

issn

1526-7598

pii

107/6/2068

journal_volume

107

pub_type

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