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PAIN MEDICINE

The Analgesic Effects of Intraperitoneal and Incisional Bupivacaine with Epinephrine After Total Abdominal Hysterectomy

A. Ng, FRCA^*, A. Swami, FFARCSI^*, G. Smith, MD, FRCA^*, A.C. Davidson, FRCOG, and J. Emembolu, FRCOG

*University Department of Anaesthesia, Critical Care, and Pain Management, and Department of Obstetrics and Gynaecology, Leicester Royal Infirmary, Leicester LE1 5WW, United Kingdom

Address correspondence to A. Ng, FRCA, and reprint requests to G. Smith, MD, FRCA, Department of Anesthesia, Critical Care, and Pain Management, University Hospitals of Leicester, NHS Trust, Leicester Royal Infirmary, LE1 5WW. Address e-mail to anae{at}le.ac.uk

The objective of our study was to see if incisional and intraperitoneal bupivacaine with epinephrine produces analgesia after total abdominal hysterectomy. Forty-six ASA physical status I and II patients received a standardized anesthetic, patient-controlled analgesia (PCA) morphine, and rectal paracetamol 1 g every 6 h. Patients were randomized to receive 50 mL of bupivacaine 0.25% with epinephrine 5 µg/mL or 50 mL of normal saline. Thirty milliliters and 20 mL of treatment solution were administered into the peritoneum and incision, respectively, before wound closure. Seventeen and 16 patients in the Placebo and Bupivacaine groups, respectively, completed the study. The reasons for withdrawal were PCA malfunction, PCA discontinued too early, nausea, chest infection, intraabdominal drain insertion, and protocol violation. There were no significant differences between the Bupivacaine and Placebo groups in age, height, weight, or duration of surgery. Pain on movement was significantly more intense in the Placebo group than in the Bupivacaine group on awakening. Morphine consumption (interquartile range) over 24 h was 62 mg (53–85 mg) in the Placebo group compared with 44 mg (33–56 mg) in the Bupivacaine group (P < 0.01). This significant difference was attributable to the larger morphine consumption in the Placebo group in the first 4 postoperative h. We conclude that a combination of intraperitoneal and incisional bupivacaine with epinephrine provides significant morphine-sparing analgesia for 4 h after total abdominal hysterectomy.

IMPLICATIONS: A combination of intraperitoneal and incisional bupivacaine with epinephrine may be recommended because it provides significant morphine-sparing analgesia for 4 h after total abdominal hysterectomy.

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