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Postoperative pain after abdominal hysterectomy: A double-blind comparison between placebo and local anesthetic infused intraperitoneally
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.ORCID iD: 0000-0001-6128-7752
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Division of Anesthesiology, University hospital, Örebro.
Division of Anesthesiology, University hospital, Örebro.
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2004 (English)In: Anesthesia and Analgesia, ISSN 0003-2999, E-ISSN 1526-7598, Vol. 99, no 4, p. 1173-1179Article in journal (Refereed) Published
Abstract [en]

Abdominal hysterectomy is associated with moderate to severe postoperative pain. We randomly divided 40 patients (ASA status I-II) undergoing elective abdominal hysterectomy into 2 groups: group P received an infusion of normal saline 5 mL/h via a catheter placed intraperitoneally at the end of surgery, and group L received 0.25% levobupivacaine 12.5 mg/h (5 mL/h). Ketobemidone was administered IV via a patient-controlled analgesia pump as a rescue analgesic in all patients. The catheter was removed after 24 h. Incisional pain, deep pain, and pain on coughing were assessed 1, 2, 3, 4, 8, 16, and 24 h after surgery by using a visual analog scale. Ketobemidone consumption during 0-72 h was recorded. Time to sit, walk, eat, and drink; home discharge; and plasma concentrations of levobupivacaine were also determined. Pain at the incision site, deep pain, and pain on coughing were all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the mean visual analog scale pain scores at rest and during coughing remained <3 cm during most time periods. Total ketobemidone consumption during 4-24 h was significantly less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less frequent incidence of postoperative nausea, but not vomiting, was also found during 4-24 h in group L compared with group P (P < 0.025). Total and free plasma concentrations of levobupivacaine were small. We conclude that levobupivacaine used as an infusion intraperitoneally after elective abdominal hysterectomy has significant opioid-sparing effects.

Place, publisher, year, edition, pages
2004. Vol. 99, no 4, p. 1173-1179
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-32067DOI: 10.1213/01.ANE.0000130260.24433.A2ISI: 000224039900040OAI: oai:DiVA.org:oru-32067DiVA, id: diva2:657327
Available from: 2013-10-18 Created: 2013-10-18 Last updated: 2017-12-06Bibliographically 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
Supervisors
Available from: 2013-09-18 Created: 2013-09-18 Last updated: 2017-10-18Bibliographically approved

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Gupta, AnilPerniola, AndreaAxelsson, Kjell

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