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Postoperative pain after abdominal hysterectomy: a randomized, doubleblind,controlled trial comparing continuous infusion vs. patient-controlled intraperitoneal injection of local anesthetic
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Department of Anesthesiology and Intensive Care, Örebro University Hospital.
Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro University, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
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2014 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, no 2, p. 328-336Article in journal (Refereed) Published
Abstract [en]

Background. Local anaesthetics (LA) injected intraperitoneally (i.p.) have been found to decrease postoperative pain. This double-blind randomized study was performed comparing continuous infusion or patient-controlled bolus injection of LA i.p. The primary endpoint was supplemental opioid consumption during the first 24 postoperative hours.

Methods. Two multi-hole catheters were placed i.p. at the end of the surgery in 40 patients undergoing elective abdominal hysterectomy. The patients were randomized into two groups: Group P: patients self-injected 10 ml of levobupivacaine 1.25 mg ml21 via the i.p. catheter as needed, maximum once/hour, and had continuous saline infusion 10 ml h21 into the second catheter. Group C: Patients received a continuous infusion of 10 ml h21 of levobupivacaine 1.25 mg ml21 i.p. through one catheter and 10 ml saline as bolus as needed via the other. Ketobemidone i.v. was administered as rescue medication.

Results. Total ketobemidone consumption during 0–24 hwas lower in Group P compared with Group C, (mean 23.1 vs 35.7 mg, P¼0.04). No differences in the median pain scores were found between the groups. Earlier return of gastrointestinal (GI) function was found in Group P vs Group C (mean 1.5 vs 2.2 days, P,0.01), which also resulted in earlier home-readiness (mean 1.9 vs 2.7 days, P¼0.04).

Conclusions. A statistically significant opioid-sparing effect was found when patientcontrolled levobupivacaine was administered i.p. as needed compared with continuous infusion. This was associated with a faster return of GI function and home-readiness. There was, however, a wide confidence interval in the primary endpoint, opioid consumption.

Place, publisher, year, edition, pages
Oxford University Press, 2014. Vol. 112, no 2, p. 328-336
Keywords [en]
abdominal hysterectomy; local anaesthetics; postoperative pain
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-32071DOI: 10.1093/bja/aet345ISI: 000330433400017PubMedID: 24185607Scopus ID: 2-s2.0-84892760154OAI: oai:DiVA.org:oru-32071DiVA, id: diva2:657396
Note

Funding Agency:

Research Committee, Örebro County Council, Örebro, Sweden

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
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Available from: 2013-09-18 Created: 2013-09-18 Last updated: 2017-10-18Bibliographically approved

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Perniola, AndreaFant, F.Axelsson, KjellGupta, Anil

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