[Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy].
OBJECTIVE
To assess the quality of postoperative analgesia provided by intravenous administration of paracetamol and ketorolac plus morphine in bolus doses with or without continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. Patient satisfaction was included among the outcomes assessed.


METHODS
Prospective pilot study in ASA 1-2 patients randomized to 2 groups: women in the subcutaneous catheter group received intravenous analgesics plus a continuous infusion (2 mL/h) of 0.25% bupivacaine whereas women in the control group received only the intravenous analgesics. The outcome measures were pain intensity assessed on a verbal numerical scale at rest and with movement, morphine requirements in the first 48 hours after surgery, and complications related to the drugs used or the technique.


RESULTS
Twenty-six patients were enrolled; 10 were randomized to the catheter group and 16 to the control group. Statistically significant between-group differences in pain both at rest and with movement were found while the women were in the postoperative recovery unit. Postoperative pain with movement was also significantly different at 24 hours (P<.004) and 48 hours (P<.02). Similarly, mean (SD) morphine requirements in the recovery unit were significantly greater in the control group, at 8 (2.27) mg, compared with 3.20 (1.79) mg in the catheter group (P<.002). Walking began earlier in the catheter group. No differences were found in the incidences of complications.


CONCLUSIONS
Postoperative pain is effectively relieved by continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. This technique provides good analgesia with less morphine consumption and scarce adverse effects. Patient satisfaction and the sense of receiving quality pain management are high.
Servicio de Anestesiología y Reanimación, 1Complexo Hospitalario Universitario A Coruña, Coruña. magoris@hotmail.com
M A
MA
Gómez Ríos
L
L
Vázquez Barreiro
L
L
Nieto Serradilla
J C
JC
Diz Gómez
S
S
López Alvarez
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D036502:Infusions, Intralesional; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D010865:Pilot Projects; D011446:Prospective Studies
D000779:Anesthetics, Local