Preemptive bupivacaine offers no advantages to postoperative wound infiltration in analgesia for outpatient breast biopsy.
BACKGROUND
Adequate analgesia is important after surgery and in particular after ambulatory surgery. Preemptive administration of analgesics, ie, prior to commencing surgery, has many theoretical advantages.


METHODS
In this prospective randomized study, the use of preincisional bupivacaine was compared with a postincision dose for the relief of postoperative pain, in 74 patients undergoing day-case breast biopsy.


RESULTS
Demographic criteria were similar in both groups. There were no differences in pain scores postoperatively on the visual analog scale (VAS): VAS at 30 minutes 4.5 ([SD] 2.4) versus 4.7 (1.9); P = not significant (NS); VAS at 60 minutes 3.3 (2. 3) versus 3.6 (2.2); P = NS; VAS at 120 minutes 1.9 (1.7) versus 2.5 (2.0); P = NS; VAS at 240 minutes 0.9 (1.0) versus 1.3 (1.4); P = NS. There was no difference in the number of patients requiring additional analgesia: 13 (36%) versus 18 (47%); P = NS. Nor was there a difference in the time to additional analgesia: 55.0 (37.8) versus 55.3 (39.2) minutes; P = NS.


CONCLUSIONS
The administration of local anaesthesia prior to starting surgery does not appear to have any advantage over its postoperative administration in patients undergoing ambulatory breast biopsy.
O'Hanlon
D M
DM
National Breast Cancer Research Institute and the Department of Surgery, Galway, Ireland.
Colbert
S T
ST
Keane
P W
PW
Given
F H
FH
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000698:Analgesia; D000700:Analgesics / Q000627:therapeutic use; D000704:Analysis of Variance; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000627:therapeutic use*; D019540:Area Under Curve; D001706:Biopsy / Q000379:methods*; D001940:Breast / Q000473:pathology*; D002045:Bupivacaine / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011292:Premedication; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors
D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine