title: The effect of peri-stomal infiltration with bupivacaine/epinephrine on post-operative pain, nausea and ease of surgery in reversal of loop ileostomies.
abstract: OBJECTIVE
  Evidence to support the routine use of local anaesthetic in the reversal of loop ileostomy is equivocal. This randomized control study looked at the use of peri-operative infiltration of stoma with 0.25% bupivacaine with 1/200,000 epinephrine on the ease of surgery and its effect on post-operative pain and nausea.
  
  
  METHODS
  Sixty patients were randomized to receive peri-stomal infiltration with either 0.25% bupivacaine with 1/200,000 epinephrine or normal saline. The surgeon graded the surgery as straightforward, intermediate or difficult, and the time for the operation was also recorded. Post-operatively, analgesia was provided via PCA for 24 h. Post-operative pain and nausea scores and total morphine usage median (inter-quartile range) were compared using the Mann-Whitney U test with p < 0.05 considered significant.
  
  
  RESULTS
  There was no difference between the local anaesthetic groups and controls with respect to opiate consumption (p = 0.4), post-operative pain (p = 0.72) or nausea (p = 0.78). Shorter total anaesthetic and operative times were noted in study group, but this was not significant (p = 0.55). However, surgery was found to be easier in the local anaesthetic group (p = 0.0046).
  
  
  CONCLUSIONS
  Peri-stomal infiltration with 0.25% bupivacaine with 1/200,000 epinephrine does not impact on post-operative pain and nausea scores or opiate analgesia use. However, its use is recommended as an aid to dissection in surgery.
authors.affiliation: Department of Surgery, Monklands Hospital, Airdrie, UK.
authors.forename: Kawan
authors.initials: K
authors.lastname: Shalli
authors.forename: C
authors.initials: C
authors.lastname: Watson
authors.forename: Lynn
authors.initials: L
authors.lastname: McCaffer
authors.forename: David
authors.initials: D
authors.lastname: Clough
authors.forename: Vimty
authors.initials: V
authors.lastname: Muir
authors.forename: Angus
authors.initials: A
authors.lastname: Macdonald
mesh_terms: D000328:Adult; D000368:Aged; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use*; D003710:Demography; D004837:Epinephrine / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000150:complications / Q000188:drug therapy*; D010149:Postoperative Pain / Q000150:complications / Q000188:drug therapy*; D054047:Surgical Stomas; D013997:Time Factors
chemical_list: D002045:Bupivacaine; D004837:Epinephrine
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