title: The preemptive effect of pre-incisional bupivacaine infiltration on postoperative analgesia following lower abdominal surgery under epidural anesthesia.
abstract: BACKGROUND
  In attempts to reduce central sensitization after tissue injury, the concept of preemptive analgesia has evolved. The aim of the present study was to evaluate the preemptive effect of pre-incisional infiltration of the surgical area with bupivacaine on pain following lower abdominal surgery under epidural anesthesia.
  
  
  METHODS
  Sixty female patients scheduled for lower abdominal surgery under epidural anesthesia with bupivacaine were randomly divided into two Groups (n = 30, each). Five minutes before surgical incision, patients in Group 1 received subcutaneous infiltration of the proposed surgical area with 30 ml of 0.125% bupivacaine (with 1/200,000 epinephrine), while those in Group 2 received 30 ml of isotonic saline (with 1/200,000 epinephrine) infiltration. Postoperatively, pain was assessed for 48 h by a visual analogue scale of pain at rest, during cough and by cumulative morphine doses (self-administered by patient-controlled analgesia).
  
  
  RESULTS
  The pain score at rest was significantly lower in Group 1 than in Group 2 from the 6th h to the 24th h postoperatively. The cough-associated pain score was lower in Group 1 than in Group 2 from the 6th h to the 28th h postoperatively. Furthermore, Group 1 consumed less morphine than did Group 2 from the 6th h to the 24th h postoperatively.
  
  
  CONCLUSIONS
  The results indicate that pre-incisional infiltration of surgical area with bupivacaine markedly decreases the intensity of pain following lower abdominal surgery under epidural anesthesia.
authors.affiliation: Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taiwan, R.O.C.
authors.forename: S J
authors.initials: SJ
authors.lastname: Huang
authors.forename: J J
authors.initials: JJ
authors.lastname: Wang
authors.forename: S T
authors.initials: ST
authors.lastname: Ho
authors.forename: H S
authors.initials: HS
authors.lastname: Liu
authors.forename: W J
authors.initials: WJ
authors.lastname: Liaw
authors.forename: M J
authors.initials: MJ
authors.lastname: Li
authors.forename: Y H
authors.initials: YH
authors.lastname: Liu
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine