Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain.
OBJECTIVE
To compare the efficacy of preincision wound infiltration with bupivacaine to wound infiltration at the end of the operation.


METHODS
A prospective, randomized, double-blind study.


METHODS
University medical center.


METHODS
56 ASA status I and II women scheduled for abdominal hysterectomy were randomly assigned to one of three treatment groups.


METHODS
Group 1 (control) received no local anesthetic infiltration. Group 2 received subcutaneous infiltration with 40 ml of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Group 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg i.v., droperidol 50 micrograms/kg i.v., and sufentanil 0.5 microgram/kg i.v. and maintained with nitrous oxide 67% in oxygen and sufentanil 0.1 microgram/kg IV boluses as required. Postoperative pain was treated with morphine via a patient-controlled analgesia delivery system for 24 hours, followed by oral hydrocodone for 3 days.


RESULTS
The opioid consumption was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups.


CONCLUSIONS
Wound infiltration, either preincision or postincision, had no clinically significant effect on the pain scores or analgesic requirements following abdominal hysterectomy.
Victory
R A
RA
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas 75235-9068, USA.
Gajraj
N M
NM
Van Elstraete
A
A
Pace
N A
NA
Johnson
E R
ER
White
P F
PF
D000328:Adult; D002045:Bupivacaine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011182:Postoperative Care; D011292:Premedication; D011446:Prospective Studies
D002045:Bupivacaine