Wound infiltration with bupivacaine and intramuscular diclofenac reduces postoperative tramadol consumption in patients undergoing radical retropubic prostatectomy: a prospective, double-blind, placebo-controlled, randomized study.
OBJECTIVE
To assess the impact of wound infiltration with bupivacaine and i.m. diclofenac administration on patient-controlled analgesia (PCA) tramadol consumptions and postoperative pain in patients who underwent radical retropubic prostatectomy (RRP) under general anesthesia. Previous studies have found only limited or no benefits of local anesthetics for postoperative opioid consumption and pain relief after RRP.


METHODS
In this prospective, double-blind, placebo-controlled, randomized trial, 96 men who underwent RRP were randomized into 2 groups. Each group (n = 48) received either wound infiltration with 0.5% bupivacaine during surgical closure and i.m. 75 mg diclofenac (group BD) or wound infiltration with saline during surgical closure and i.m. saline (group P). PCA with i.v. tramadol was used for postoperative analgesia. PCA tramadol consumptions and pain scores were collected at 1, 2, 6, 12, and 24 hours postoperatively.


RESULTS
The mean cumulative tramadol consumption was significantly lower in group BD (184.43 ± 38.58 mg) compared with group P (269.52 ± 52.46) at 24 hours (P <.001). The pain scores were significantly lower in group BD compared with group P (P <.05). The number of patients who required rescue antiemetic and analgesic was lower in group BD than in group P, revealing a significant difference (P <.05). Patients' satisfaction scores were significantly higher in group BD than in group P (P <.001).


CONCLUSIONS
This prospective, double-blind, placebo-controlled, randomized study demonstrated that wound infiltration with bupivacaine during surgical closure combined with i.m. diclofenac administration might decrease in 24 hours with PCA tramadol consumption in patients who underwent RRP under general anesthesia.
Department of Anesthesiology and Reanimation, University of Mersin School of Medicine, Mersin, Turkey.
Tugsan Egemen
TE
Bilgin
Murat
M
Bozlu
Sebnem
S
Atici
Selahittin
S
Cayan
Bahar
B
Tasdelen
D000368:Aged; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004008:Diclofenac / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D017060:Patient Satisfaction; D011468:Prostatectomy / Q000009:adverse effects* / Q000379:methods; D014147:Tramadol / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D014147:Tramadol; D002045:Bupivacaine