title: Continuous infusion of local anaesthetic following laparoscopic hysterectomy--a randomised controlled trial.
abstract: OBJECTIVE
  To estimate whether a continuous infusion of intraperitoneal local anaesthetic for 48 hours following laparoscopic hysterectomy reduced the need for opioids delivered with a patient-controlled analgesia pump.
  
  
  METHODS
  Double-blind randomised placebo-controlled trial.
  
  
  METHODS
  District general hospital in the UK.
  
  
  METHODS
  Women undergoing a laparoscopic hysterectomy for a benign indication.
  
  
  METHODS
  Women were randomised to receive either 0.5% levobupivicaine or 0.9% normal saline via an ON-Q elastomeric pump for 48 hours postoperatively. The amount of opioids used via the patient-controlled analgesia pump was recorded and pain was measured using an 11-point Box Scale.
  
  
  METHODS
  The primary outcome was the amount of patient-administered morphine used over the first 48 postoperative hours. Secondary outcomes were length of hospital stay, oral analgesia use and level of patient-reported pain.
  
  
  RESULTS
  Sixty women participated and completed the trial. There was no difference (P = 0.59) in the median amount of patient-administered morphine used between the levobupivicaine (23 mg) and placebo (18.5 mg) groups; median group difference 3.0 (95% CI -7.0 to 14.0). There was also no difference in the length of hospital stay with 40% of the treatment group remaining in hospital >48 hours compared with 30% of the placebo group (P = 0.08). Pain scores at all postoperative time points remained similar, with a median group difference in pain scores of 1.0 (95% CI -1.0 to 2.0) at the end of the first postoperative day.
  
  
  CONCLUSIONS
  Continuous infusion of 0.5% levobupivicaine into the peritoneal cavity following laparoscopic hysterectomy does not have any opioid-sparing effects.
authors.affiliation: Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, Surrey, UK.
authors.forename: V
authors.initials: V
authors.lastname: Andrews
authors.forename: J T
authors.initials: JT
authors.lastname: Wright
authors.forename: F
authors.initials: F
authors.lastname: Zakaria
authors.forename: S
authors.initials: S
authors.lastname: Banerjee
authors.forename: K
authors.initials: K
authors.lastname: Ballard
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods; D007274:Injections, Intraperitoneal; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017211:Treatment Failure; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine
keywords: Hysterectomy; intraperitoneal; laparoscopy; local anaesthetic