Wound infiltration with ropivacaine and fentanyl: effects on postoperative pain and PONV after breast surgery.
OBJECTIVE
To determine whether postoperative wound infiltration with local anesthetics combined with fentanyl improves analgesia following breast surgery; and to investigate awakening and postoperative nausea/vomiting.


METHODS
Prospectively randomized clinical study.


METHODS
University hospital.


METHODS
45 ASA physical status I and II patients scheduled for breast surgery.


METHODS
Patients were prospectively randomized and assigned to one of three treatments during general anesthesia: postsurgical wound infiltration with ropivacaine 0.375%; wound infiltration with ropivacaine 0.375% combined with fentanyl 0.5 microg/kg; and intravenous (i.v.) fentanyl 0.5 microg/kg before skin incision and no wound infiltration. Time to first verbal response, pain at rest, postoperative nausea and vomiting, and ketobemidone and dixyrazine utilization were compared.


RESULTS
Time to first verbal response was significantly shorter in the i.v. fentanyl group compared to both infiltration groups (8.1 +/- 4.5 min vs. 15.3 +/- 4.3, and 12.0 +/- 5.0 min; p < 0.05, respectively). Postoperative pain at rest, and nausea and vomiting occurred with similar frequencies in the groups. Ketobemidone utilization in both infiltration groups, (2.4 +/- 1.8 mg and 3.1 +/- 1.8 mg, respectively) was not different compared to the i.v. fentanyl group (2.9 +/- 2.0 mg; NS). There were no differences in postoperative antiemetic requirements during the first, second and third two-hour periods postoperatively. The dixyrazine consumption was similar in the three groups, (0.9 +/- 1.5 mg, 0.8 +/- 1.3 mg, and 1.4 +/- 1.8 mg, respectively; NS).


CONCLUSIONS
Postsurgical ropivacaine wound infiltration, with or without adding fentanyl, demonstrates no differences in postoperative pain relief and nausea/vomiting compared to a balanced general anesthetic including i.v. fentanyl.
Johansson
Anders
A
Department of Anesthesiology and Intensive Care, Lund University Hospital, Lund, Sweden.
Kornfält
Jonas
J
Nordin
Lena
L
Svensson
Lena
L
Ingvar
Christian
C
Lundberg
Johan
J
D000577:Amides / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D019162:Anesthetics, Combined / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001365:Axilla; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008197:Lymph Node Excision; D015412:Mastectomy, Segmental; D008614:Meperidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*; D011446:Prospective Studies; D000077212:Ropivacaine
D000577:Amides; D000701:Analgesics, Opioid; D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008614:Meperidine; C012394:ketobemidone; D005283:Fentanyl