title: Postoperative pain after abdominal hysterectomy: a randomized, double-blind, controlled trial comparing continuous infusion vs patient-controlled intraperitoneal injection of local anaesthetic.
abstract: BACKGROUND
  Local anaesthetics (LA) injected intraperitoneally have been found to decrease postoperative pain. This double-blind randomized study was performed comparing continuous infusion or patient-controlled intraperitoneal (i.p.) bolus injection of LA. The primary endpoint was supplemental opioid consumption during the first 24 postoperative hours.
  
  
  METHODS
  Two multi-hole catheters were placed intraperitoneally at the end of the surgery in 40 patients undergoing elective abdominal hysterectomy. The patients were randomized into two groups: Group P: patients self-injected 10 ml of levobupivacaine 1.25 mg ml(-1) via the i.p. catheter as needed, maximum once per hour, and had continuous saline infusion 10 ml h(-1) into the second catheter. Group C: patients received a continuous infusion of 10 ml h(-1) of levobupivacaine 1.25 mg ml(-1) intraperitoneally through one catheter and 10 ml saline as bolus as needed via the other. Ketobemidone was administered intravenously as rescue medication.
  
  
  RESULTS
  Total ketobemidone consumption during 0-24 h was lower in Group P compared with Group C (mean 23.1 vs 35.7 mg, P=0.04). No differences in the median pain scores were found between the groups. Earlier return of gastrointestinal (GI) function was found in Group P vs Group C (mean 1.5 vs 2.2 days, P<0.01), which also resulted in earlier home-readiness (mean 1.9 vs 2.7 days, P=0.04).
  
  
  CONCLUSIONS
  A statistically significant opioid-sparing effect was found when patient-controlled levobupivacaine was administered intraperitoneally as needed compared with continuous infusion. This was associated with a faster return of GI function and home-readiness. There was, however, a wide confidence interval in the primary endpoint, opioid consumption.
authors.affiliation: Department of Anesthesiology and Intensive Care and.
authors.forename: A
authors.initials: A
authors.lastname: Perniola
authors.forename: F
authors.initials: F
authors.lastname: Fant
authors.forename: A
authors.initials: A
authors.lastname: Magnuson
authors.forename: K
authors.initials: K
authors.lastname: Axelsson
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007274:Injections, Intraperitoneal; D000077554:Levobupivacaine; D008614:Meperidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008614:Meperidine; D000077554:Levobupivacaine; C012394:ketobemidone; D002045:Bupivacaine
keywords: abdominal hysterectomy; local anaesthetics; postoperative pain