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Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study
Örebro University, School of Health and Medical Sciences.
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2009 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 26, no 5, p. 421-429Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND OBJECTIVE: Local anaesthetics administered intraabdominally have been found to reduce analgesic requirements postoperatively after hysterectomy. This study was designed to assess the optimal dose of local anaesthetics for best pain relief.

METHODS: Sixty patients undergoing abdominal hysterectomy were randomly divided into three groups to receive 10 ml h infusion of levobupivacaine intraabdominally postoperatively for 48 h in a double-blind manner: group L, 7.5 mg h; group M, 12.5 mg h and group H, 17.5 mg h. Pain intensity was measured using the numeric rating scale, ketobemidone consumption over 48 h was measured with a patient-controlled analgesia pump, recovery parameters, expiratory muscle strength, time to home readiness, plasma concentration of levobupivacaine and health-related quality of life were all measured at defined time points postoperatively.

RESULTS: No differences were found between the active groups in pain intensity, recovery parameters or health-related quality of life. Pain intensity was maximal during 0-4 h and during coughing. Expiratory muscle strength decreased significantly during 0-4 h in all active groups, with no differences between the groups. Plasma concentration of levobupivacaine was below known toxic concentrations in humans, and no patient had symptoms of local anaesthetic toxicity. Health-related quality of life showed improved scores at 3 months after the operation compared with preoperative values, but no differences between the groups were found in any of the parameters.

CONCLUSION: Satisfactory analgesia can be achieved with low doses of levobupivacaine administered intraabdominally, except during the early postoperative period. No advantages were seen in this study when higher doses of levobupivacaine were administered as a continuous infusion for postoperative pain relief.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2009. Vol. 26, no 5, p. 421-429
National Category
Medical and Health Sciences Anesthesiology and Intensive Care
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-12118DOI: 10.1097/EJA.0b013e3283261b53ISI: 000265561700011PubMedID: 19521298Scopus ID: 2-s2.0-70149107139OAI: oai:DiVA.org:oru-12118DiVA, id: diva2:355616
Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12Bibliographically approved
In thesis
1. A new technique for postoperative pain management with local anesthetic after abdominal hysterectomy
Open this publication in new window or tab >>A new technique for postoperative pain management with local anesthetic after abdominal hysterectomy
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

An abdominal hysterectomy (AH) is associated with moderate to severe postoperative pain. In this thesis, a new technique for postoperative pain managment has been studied in 200 patients: local anesthetic (LA) was administered intraperitoneally (IP) after elective AH.

In study I, the efficacy of an IP continuous infusion of LA given postoperatively via a catheter was compared with a placebo. The conclusion was that the postoperative pain relief was significantly improved when LA was used. The plasma concentration of LA was far below toxic concentrations.

In study II, when three different doses of LA were given at a constant infusion rate, the conclusion was that satisfactory analgesia could be achieved with low doses of LA and that no advantages were seen when higher doses of LA were administered. The highest dose of infused LA did not result in toxic plasma concentration.

Study III compared a continuous IP infusion and a patient-controlled bo-lus IP injection of LA. A significant opioid-sparing effect combined with lower required amount of LA was found when the patient-controlled LA was administered compared to the continuous infusion. This was associated with a faster return of gastrointestinal function and home readiness.

Study IV tested the hypothesis that the analgesic effect of LA given intermittently IP was superior compared to the same dose administered continuously by intravenous (IV) infusion. A significant opioid-sparing effect was found when an intermittent IP injection of lidocaine was administered. The venous blood concentration of LA was significantly lower in the IP intermittent group versus the IV group. The lower supplemental morphine consumption, coupled with the lower plasma lidocaine concentration, may confirm a local peripheral rather than a systemic effect of LA administered IP.

In conclusion, when the LA was injected continuously IP, a significant opioid- sparing effect was found, which did not increase by increasing the LA dose. The opioid-sparing effect was greater when the intermittent IP injection of LA was compared to a continuous infusion. When LA was administered IP, the mechanism of pain relief seemed to be a local rather than a central effect.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2013. p. 65
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 94
Keywords
local anesthetics, postoperative pain, abdominal hysterectomy, intra-peritoneal, catheter, Lidocaine, Levobupivacaine
National Category
Anesthesiology and Intensive Care Surgery
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-30851 (URN)978-91-7668-967-7 (ISBN)
Public defence
2013-11-08, Wilandersalen, Universitetssjukhuset Örebro, S. Grev Rosengatan, 703 62 Örebro, 09:00 (Swedish)
Opponent
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Available from: 2013-09-18 Created: 2013-09-18 Last updated: 2017-10-18Bibliographically approved

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Perniola, AndreaGupta, AnilDarvish, Bijan

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