title: Bupivacaine infusion above or below the fascia for postoperative pain treatment after abdominal hysterectomy.
abstract: BACKGROUND
  We evaluated in which anatomic layer (above the fascia [AF] or below the fascia [BF]) wound infusion of bupivacaine has the best effect on postoperative pain after abdominal hysterectomy.
  
  
  METHODS
  Sixty-two ASA physical status I and II patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy were enrolled into this prospective randomized, double-blind study. A standard general anesthetic was administered. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above (group AF, n = 29) or below (group BF, n = 31) the superficial abdominal fascia and 0.25% bupivacaine was administered via a patient-controlled analgesia device, programmed to deliver 9.0 mL with a 60-min lockout interval for 24 h. During the first 6 h after surgery, rescue i.v. fentanyl (25 microg) was administered to achieve a visual analog scale score of <4 cm. Total bupivacaine consumption, total rescue fentanyl consumption, pain scores (with resting, coughing, and leg raising), and patient satisfaction scores were compared in both groups.
  
  
  RESULTS
  Total bupivacaine consumption over 24 h was significantly lower in group AF rather than group BF (90 +/- 26 mL vs 104 +/- 28 mL, respectively, P < 0.05). The total fentanyl consumption during the first 6 h after surgery was 109 +/- 59 microg in group AF and 166 +/- 70 microg in group BF (P < 0.01). Pain scores were lower in group AF at rest and coughing for the first 5 h and for the first 12 h with leg raise (P < 0.05 for all measurements). Thirteen patients (68%) in group AF defined their satisfaction as excellent whereas six patients (32%) in group BF defined their satisfaction as excellent (P = 0.034).
  
  
  CONCLUSIONS
  We conclude that bupivacaine wound infusion AF provides better postoperative analgesia compared with infusion BF in the first 12 h after abdominal hysterectomy.
authors.affiliation: Izmir Ataturk Training and Research Hospital, Department of Anesthesiology and Reanimation, 35000 Basinsitesi, Izmir, Turkey.
authors.forename: Meltem Cakmak
authors.initials: MC
authors.lastname: Hafizoglu
authors.forename: Kaan
authors.initials: K
authors.lastname: Katircioglu
authors.forename: Murat Y
authors.initials: MY
authors.lastname: Ozkalkanli
authors.forename: Serdar
authors.initials: S
authors.lastname: Savaci
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005205:Fascia; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine