title: Wound infusion of bupivacaine following radical retropubic prostatectomy:  a randomised placebo-controlled clinical study.
abstract: BACKGROUND
  The effectiveness of postoperative analgesia through a wound catheter is subject to considerable debate.
  
  
  OBJECTIVE
  To test the hypothesis that local wound infusion with bupivacaine followed by continuous infusion could reduce postoperative need for opioids in patients undergoing retropubic prostatectomy.
  
  
  METHODS
  Single-centre prospective, double-blinded, placebo-controlled trial.
  
  
  METHODS
  A major university hospital in Denmark.
  
  
  METHODS
  Following written informed consent, 60 patients scheduled for prostatectomy were recruited to the study and 50 completed the protocol to reach data analysis.
  
  
  METHODS
  Thirty millilitre bolus of bupivacaine (2.5 mg ml) or isotonic saline was injected through a subfascially placed wound catheter followed by continuous infusion at 5 ml h during the following 48 h. All patients were prescribed paracetamol, non-steroidal anti-inflammatory drugs, morphine and oxycodone if needed.
  
  
  METHODS
  Primary outcome was the opioid requirement. Secondary outcomes included pain scores at rest and with activity, and nausea and vomiting scores.
  
  
  RESULTS
  The total amount of morphine required during the postoperative period was not significantly higher (P=0.49) in the placebo group (12 mg, 25 to 75% percentile 5 to 18) than the bupivacaine group (10 mg, 25 to 75% percentile 0 to 16). Similarly, the total amount of oxycodone required was not significantly different (P=0.99) and was equal among the groups (5 mg, 25 to 75% percentile 5 to 10). At 2 h postoperatively, a significantly (P=0.0488) higher number of patients required additional morphine in the placebo group. No differences between the groups were detected at any time point regarding pain scores or the presence of nausea and vomiting.
  
  
  CONCLUSIONS
  Additional use of a wound catheter in patients undergoing prostatectomy in the present perioperative setting appears superfluous.
authors: Department of Anaesthesiology and Intensive Care, Aarhus University Hospital Skejby, Skejby, Aarhus, Denmark. bsk@dadlnet.dk
authors: Bo S
authors: BS
authors: Kristensen
authors: Christian
authors: C
authors: Fenger-Eriksen
authors: Knud V
authors: KV
authors: Pedersen
authors: Sven
authors: S
authors: Felsby
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D057785:Catheters; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010146:Pain; D010147:Pain Measurement; D011184:Postoperative Period; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine