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ANALGESIA

Bupivacaine Infusion Above or Below the Fascia for Postoperative Pain Treatment After Abdominal Hysterectomy

From the Izmir Ataturk Training and Research Hospital, Department of Anesthesiology and Reanimation, Izmir, Turkey.

Address correspondence and reprint requests to Kaan Katircioglu, Izmir Ataturk Training and Research Hospital, Department of Anesthesiology and Reanimation, 35000 Basinsitesi, Izmir, Turkey. Address e-mail to kaankat{at}yahoo.com.

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 IV fentanyl (25 µg) 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 µg in group AF and 166 ± 70 µg 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.