Preoperative infiltration of bupivacaine--effects on pain relief and trauma response (cortisol and interleukin-6).
OBJECTIVE
Subcutaneous infiltration of bupivacaine before skin incision can reduce postoperative pain and modulate the stress response.


METHODS
In a randomized study on pain relief after hysterectomy 29 patients were referred into one of three groups, receiving 30 ml of bupivacaine 0.25% with adrenaline, 30 ml of saline or no infiltration along the line of the proposed incision 10 min before start of surgery. A Visual Analogue Scale was used for repeated pain ratings. Postoperative pain relief was provided with patient-controlled analgesia with intravenous morphine 0.04 mg/kg. Lockout time was 10 min. The immunological and endocrine stress response to trauma was reflected by blood interleukin-6 (IL-6) and cortisol concentrations measured during 72 h following skin incision.


RESULTS
There were large individual variations in the accumulated postoperative consumption of morphine at 20 h after start of surgery. It was significantly reduced in patients receiving infiltration of bupivacaine. They used 39 mg (9-62) median (range) of intravenous morphine whereas the patients in the saline group used 65 mg (47-120) and patients in the control group used 54 mg (36-130) (P < 0.05). Significant elevation of plasma IL-6 and serum cortisol levels appeared in all groups with peak values at 3 h. There were no differences between the groups. There was a correlation between cortisol and IL-6. Six of the 29 patients had a postoperative infection which was reflected in increased IL-6 levels.


CONCLUSIONS
Preoperative subcutaneous infiltration of bupivacaine significantly reduced the postoperative consumption of intravenous morphine.
Eriksson-Mjöberg
M
M
Department of Anaesthesia and Intensive Care, Karolinska Institute at Huddinge Hospital, Sweden.
Kristiansson
M
M
Carlström
K
K
Eklund
J
J
Gustafsson
L L
LL
Olund
A
A
D000328:Adult; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010149:Postoperative Pain / Q000517:prevention & control*
D000779:Anesthetics, Local; D015850:Interleukin-6; D009020:Morphine; D006854:Hydrocortisone; D002045:Bupivacaine