Effect of preincision versus postincision infiltration with bupivacaine on postoperative pain.

STUDY OBJECTIVE

To compare the efficacy of preincision wound infiltration with bupivacaine to wound infiltration at the end of the operation.

DESIGN

A prospective, randomized, double-blind study.

SETTING

University medical center.

PATIENTS

56 ASA status I and II women scheduled for abdominal hysterectomy were randomly assigned to one of three treatment groups.

INTERVENTIONS

Group 1 (control) received no local anesthetic infiltration. Group 2 received subcutaneous infiltration with 40 ml of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Group 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg i.v., droperidol 50 micrograms/kg i.v., and sufentanil 0.5 microgram/kg i.v. and maintained with nitrous oxide 67% in oxygen and sufentanil 0.1 microgram/kg IV boluses as required. Postoperative pain was treated with morphine via a patient-controlled analgesia delivery system for 24 hours, followed by oral hydrocodone for 3 days.

MEASUREMENTS AND MAIN RESULTS

The opioid consumption was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups.

CONCLUSIONS

Wound infiltration, either preincision or postincision, had no clinically significant effect on the pain scores or analgesic requirements following abdominal hysterectomy.