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PAIN MEDICINE

Postoperative Pain After Abdominal Hysterectomy: A Double-Blind Comparison Between Placebo and Local Anesthetic Infused Intraperitoneally

Anil Gupta, MD FRCA, PhD^*, Andrea Perniola, MD^*, Kjell Axelsson, MD PhD^*, Sven E. Thörn, MD PhD^*, Kristina Crafoord, MD, and Narinder Rawal, MD PhD^*

Department of Clinical Medicine, *Division of Anesthesiology, and Obstetrics and Gynecology, University Hospital, Örebro, Sweden

Address correspondence and reprint requests to Anil Gupta, MD, FRCA, PhD, Department of Anesthesiology and Intensive Care, University Hospital, SE 701 85 Örebro, Sweden. Address e-mail to anil.gupta{at}orebroll.se

Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I–II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0–72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1–2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4–24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4–24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.

IMPLICATIONS: A double-blind study was performed to assess postoperative pain and analgesic requirements after abdominal hysterectomy. Postoperative intraperitoneal local anesthetic infusions (levobupivacaine 12.5 mg/h) had a significant opioid-sparing effect compared with placebo and had a less frequent incidence of postoperative nausea during 4–24 h.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999