title: Local anaesthetic infiltration at the end of carotid endarterectomy improves post-operative analgesia.
abstract: BACKGROUND
  Wound infiltration at the end of carotid endarterectomy under general anaesthesia is a simple technique that can be delegated to the surgeon. It was hypothesised that this technique could improve early post-operative analgesia by reducing the need for post-operative opioids.
  
  
  METHODS
  Forty patients underwent carotid endarterectomy under general anaesthesia with desflurane and remifentanil supplemented with morphine for post-operative analgesia. In a prospective double-blinded randomised study, patients were allocated pre-operatively to receive either subcutaneous infiltration of both wound edges with 20 ml of 0.75% ropivacaine or infiltration with isotonic saline. The primary outcome was morphine consumption while in the post-anaesthesia care unit (PACU). Pain scores at rest and movement, sedation, and patient satisfaction were the other main outcomes used to assess post-operative analgesia.
  
  
  RESULTS
  The median dose of morphine administered in the PACU was 2 mg [0-3] in the ropivacaine vs. 4 mg [3-6] in the placebo group (P = 0.0004, Mann-Whitney's test). Pain at rest and at movement was lower in the ropivacaine group throughout observation in the PACU. No difference was found for both pain and opioid consumption after discharge from the PACU or for patient satisfaction. Sedative events in the early post-operative period were less frequent in the ropivacaine group.
  
  
  CONCLUSIONS
  Local anaesthetic wound infiltration performed before closure reduces the need for additional opioids, lowers the immediate post-operative pain and improves alertness. These results argue for the use of local infiltration anaesthesia for carotid endarterectomy.
authors.affiliation: Anesthésie-Réanimation, BLOC-ARCHI, CHU Clermont-Ferrand, Clermont-Ferrand, France.
authors.forename: A-L
authors.initials: AL
authors.lastname: Cherprenet
authors.forename: M
authors.initials: M
authors.lastname: Rambourdin-Perraud
authors.forename: S
authors.initials: S
authors.lastname: Laforêt
authors.forename: M
authors.initials: M
authors.lastname: Faure
authors.forename: N
authors.initials: N
authors.lastname: Guesmi
authors.forename: C
authors.initials: C
authors.lastname: Baud
authors.forename: E
authors.initials: E
authors.lastname: Rosset
authors.forename: P
authors.initials: P
authors.lastname: Schoeffler
authors.forename: C
authors.initials: C
authors.lastname: Dualé
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D000077212:Ropivacaine
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine