Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy.
OBJECTIVE
The effectiveness of local anesthetic wound infiltration for treatment of postoperative pain appears to be variable and partly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of patients undergoing day-case laparoscopic procedures with long acting local anesthetic agents. The aim of this study was to investigate the analgesic efficacy, and the influence of the timing, of local anesthetic infiltration into surgical wounds for day-case diagnostic gynecological laparoscopy.


METHODS
A double-blind, randomized trial was conducted on 100 women having general anesthesia for day-case gynecological laparoscopy. Ninety-two patients who had been randomized to 1 of 4 groups for trocar wound infiltration with 30 mL of 0.25% bupivacaine or saline either before or after surgery completed the study. Incisional pain, pain on pressing the umbilicus, severity of nausea, and patient satisfaction with anesthetic technique were all assessed postoperatively until discharge and on the following day through a telephone interview. A P value of <.05 was considered significant.


RESULTS
There was no difference between groups in the mean pain scores or analgesic requirements for incisional pain, pain on pressing firmly on the umbilicus, or for patient satisfaction. There was a trend for those patients who had received bupivacaine to use less postoperative morphine (P =.079).


CONCLUSIONS
Wound infiltration with local anaesthetic did not significantly reduce pain or opioid requirement after gynecological laparoscopy.
Department of Anaesthesia, King Edward Memorial Hospital for Women, Subiaco, Australia.
S Y
SY
Fong
T J
TJ
Pavy
S T
ST
Yeo
M J
MJ
Paech
L C
LC
Gurrin
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000768:Anesthesia, General; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000628:therapy*
D000779:Anesthetics, Local; D002045:Bupivacaine