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  • 1.
    Dahlberg, Karuna
    et al.
    Örebro University, School of Health Sciences.
    Philipsson, Anna
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Hagberg, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Jaensson, Maria
    Örebro University, School of Health Sciences.
    Hälleberg Nyman, Maria
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Cost-effectiveness of a systematic e-assessed follow-up of postoperative recovery after day surgery: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1039-1046Article in journal (Refereed)
    Abstract [en]

    Background: Most surgeries are done on a day-stay basis. Recovery assessment by phone points (RAPP) is a smartphonebased application (app) to evaluate patients after day surgery. The aim of this study was to estimate the cost-effectiveness of using RAPP for follow-up on postoperative recovery compared with standard care.

    Methods: This study was a prospective parallel single-blind multicentre randomized controlled trial. Participants were randomly allocated to the intervention group using RAPP or the control group receiving standard care. A cost-effectiveness analysis was performed based on individual data and included costs for the intervention, health effect [quality-adjusted life-years (QALYs)], and costs or savings in health-care use.

    Results: The mean cost for health-care consumption during 2 weeks after surgery was estimated at e37.29 for the intervention group and e60.96 for the control group. The mean difference was e23.66 (99% confidence interval 46.57 to0.76; P¼0.008). When including the costs of the intervention, the cost-effectiveness analysis showed net savings of e4.77 per patient in favour of the intervention. No difference in QALYs gained was seen between the groups (P¼0.75). The probability of the intervention being cost-effective was 71%.

    Conclusions: This study shows that RAPP can be cost-effective but had no effect on QALY. RAPP can be a cost-effective toolin providing low-cost health-care contacts and in systematically assessing the quality of postoperative recovery.

    Clinical trial registration:NCT02492191

  • 2.
    Fant, F.
    et al.
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Tina, Elisabet
    Örebro University Hospital. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Research Centre.
    Sandblom, D.
    Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
    Andersson, Swen-Olof
    Department of Urology and the Health Academy, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro, Sweden.
    Hultgren-Hörnquist, Elisabeth
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital, Örebro, Sweden.
    Axelsson, Kjell
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Gupta, Anil
    Department of Anesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
    Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, no 5, p. 747-757Article in journal (Refereed)
    Abstract [en]

    Background: Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropubic prostatectomy.

    Methods: Twenty-six patients were randomized to Group P (systemic opioid-based analgesia) or Group E (thoracic epidural-based analgesia) perioperatively. Induction and maintenance of anaesthesia followed a standardized protocol. The following measurements were made perioperatively: plasma cortisol, glucose, insulin, C-reactive proteins, leucocyte count, plasma cytokines [interleukin (IL)-6, tumour necrosis factor (TNF)-alpha], and pokeweed mitogen-stimulated cytokines [interferon (IFN)-gamma, IL-2, IL-12p70, IL-10, IL-4, and IL-17]. Other parameters recorded were pain, morphine consumption, and perioperative complications.

    Results: Plasma concentration of cortisol and glucose were significantly higher in Group P compared with Group E at the end of surgery, the mean difference was 232 nmol litre(-1) [95% confidence interval (CI) 84-381] (P=0.004) and 1.6 mmol litre(-1) (95% CI 0.6-2.5) (P=0.003), respectively. No significant differences were seen in IL-6 and TNF-alpha at 24 h (P=0.953 and 0.368, respectively) and at 72 h (P=0.931 and 0.691, respectively). IL-17 was higher in Group P compared with Group E, both at 24 h (P=0.001) and 72 h (P=0.018) after operation. Pain intensity was significantly greater in Group P compared with Group E (P<0.05) up to 24 h.

    Conclusions: In this small prospective randomized study, thoracic epidural analgesia reduced the early postoperative stress response but not the acute inflammatory response after radical retrobupic prostatectomy, suggesting that other pathways are involved during the acute phase reaction.

  • 3.
    Fant, Federica
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sandblom, Dag
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistical Unit, Örebro University Hospital, Örebro University, Örebro, Sweden.
    Andersson, Swen-Olof
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Thoracic epidural analgesia or patient-controlled local analgesia for radical retropubic prostatectomy: a randomized, double-blind study2011In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 107, no 5, p. 782-789Article in journal (Refereed)
    Abstract [en]

    Background.Postoperative pain after radical retropubic prostatectomy is moderate to severe. The primary aim of this study was to assess whether intra-abdominal local anaesthetics provide similar analgesia compared with thoracic epidural analgesia (TEA).

    Methods.Fifty patients, ASA I–II, participated in this prospective, doubleblinded study. All patients had TEA. After operation, they were randomized into two groups of 25 patients: Group PCLA (patient- ontrolled local analgesia): self-administration of 10 ml of ropivacaine 2 mg ml21 via the intra-abdominal catheter for 48 h. Group TEA: infusion of 10 ml h–1 of ropivacaine 1 mg ml–1, fentanyl 2mg ml21, and epinephrine 2mg ml21 epidurally for 48 h. The primary endpoint was pain on coughing at 4 h after operation. Rescue medication was morphine i.v. as required.

    Results.Pain on coughing at 4, 24, and 48 h was significantly lower in Group TEA [0 (0–10)] compared with Group PCLA [4 (0–10)] (P,0.05). Significantly lower pain intensity was also found in Group TEA compared with Group PCLA at the incision site, deep pain, and pain on coughing at 4 and 24 h (P,0.05). Morphine consumption was significantly greater in Group PCLA [12 (0–46)] compared with Group TEA [0 (0–20)] at 0–48 h after operation [median (range)] (P¼0.015). Maximum expiratory pressure was higher in Group TEA compared with Group PCLA at 24 h (P,0.01).Conclusions.TEA provides superior postoperative pain relief with better preservation of expiratory muscle strength compared with PCLA.

  • 4.
    Giesecke, Kajsa
    et al.
    Department of Anaesthesiology, Huddingc Hospital, Huddinge, Sweden.
    Klingstedt, Christer
    Department of Anaesthesiology, South Hospital, Stockholm, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
    Hagenfeldt, Lars
    Department of Clinical Chemistry, Huddinge Hospital, Huddinge, Sweden.
    The modifying influence of anaesthesia on postoperative protein catabolism1994In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 72, no 6, p. 697-699Article in journal (Refereed)
    Abstract [en]

    We studied two groups of six patients scheduled for gastrointestinal surgery; they were allocated randomly to receive high- or low-dose fentanyl anaesthesia. The confounding effect of protein balance, before the trauma of surgery, on postoperative nitrogen excretion was controlled by standardized protein intake before operation, supplemented by adequate calories. The high-dose group had significantly lower stress levels during surgery, assessed by arterial blood concentrations of cortisone, adrenaline and glucose. After operation, protein catabolism was measured for 7 days. The high-dose group had significantly lower postoperative excretion of ammonia and slightly lower excretion of urea and 3-methylhistidine. Low-stress anaesthesia may thus diminish postoperative catabolism, which could be important in frail patients by reducing mortality, ICU resources, or both. 

  • 5.
    Gornall, B. F.
    et al.
    Academic Board of Anaesthesia and Perioperative Medicine, Monash University, Clayton VIC, Australia; Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Myles, Paul S.
    Academic Board of Anaesthesia and Perioperative Medicine, Department of Epidemiology and Preventive Medicine, Monash University,Clayton VIC, Australia; Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Smith, C. L.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Burke, J. A.
    Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne Vic, Australia.
    Leslie, K.
    Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne Vic, Australia.
    Pereira, M. J.
    Department of Anaesthesia, Central Lisbon Hospital Center, Lisbon, Portugal.
    Bost, J. E.
    Biostatistics and Clinical and Translational Science, University of Pittsburgh, Pittsburgh PA, USA; Center for Research on Health Care (CRHC) Data Cente, University of Pittsburgh, Pittsburgh PA, USA.
    Kluivers, K. B.
    Department of Obstetrics and Gynecology, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
    Nilsson, Ulrica
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anaesthesia and Intensive Care, Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden; Centre for Health Care, Örebro University Hospital, Örebro, Sweden.
    Tanaka, V.
    Department of Anesthesiology, Nara Medical University, Kashihara, Japan.
    Forbes, A.
    Biostatistics Unit, Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC, Australia.
    Measurement of quality of recovery using the QoR-40:a quantitative systematic review2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Background.Several rating scales have been developed to measure quality of recovery aftersurgery and anaesthesia, but the most extensively used is the QoR-40, a 40-itemquestionnaire that provides a global score and subscores across five dimensions: patientsupport, comfort, emotions, physical independence, and pain. It has been evaluated in avariety of settings, but its overall psychometric properties (validity, reliability, ease of use,and interpretation) and clinical utility are uncertain.

    Methods.We undertook a quantitative systematic review of studies evaluatingpsychometric properties of the QoR-40. Data were combined in meta-analyses usingrandom effects models. This resulted in a total sample of 3459 patients from 17 studiesoriginating in nine countries.

    Results.We confirmed content, construct, and convergent [pooled r¼0.58, 95% confidenceinterval (CI): 0.51–0.65] validity. Reliability was confirmed by excellent intraclass correlation(pooleda¼0.91, 95% CI: 0.88–0.93), test–retest reliability (pooled r¼0.90, 95% CI: 0.86–0.92), and inter-rater reliability (intraclass correlation¼0.86). The clinical utility of theQoR-40 instrument was supported by high patient recruitment into evaluation studies(97%), and an excellent completion and return rate (97%). The mean time to completethe QoR-40 was 5.1 (95% CI: 4.4–5.7) min.

    Conclusions.The QoR-40 is a widely used and extensively validated measure of quality ofrecovery. The QoR-40 is a suitable measure of postoperative quality of recovery in arange of clinical and research situations.Keywords:health status; meta-analysis; outcomes

  • 6.
    Holm, J.
    et al.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Vidlund, Mårten
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
    Vanky, F.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Friberg, Örjan
    Örebro University Hospital. Department of Cardiothoracic Surgery and Anaesthesia, Örebro University Hospital, Örebro, Sweden.
    Håkanson, E.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Walther, S.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    Svedjeholm, R.
    Dept Cardiothorac Surg & Anaesthesia, Linköping Univ, Linköping Univ Hosp, Linköping, Sweden.
    EuroSCORE II and N-terminal pro-B-type natriuretic peptide for risk evaluation: an observational longitudinal study in patients undergoing coronary artery bypass graft surgery2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 113, no 1, p. 75-82Article in journal (Refereed)
    Abstract [en]

    Background: Postoperative heart failure remains the major cause of death after cardiac surgery. As N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a predictor for postoperative heart failure, the aim was to evaluate if preoperative NT-proBNP could provide additional prognostic information to the recently launched EuroSCORE II.

    Methods: A total of 365 patients with acute coronary syndrome (ACS) undergoing isolated coronary artery bypass graft (CABG) surgery were studied prospectively. Preoperative NT-proBNP and EuroSCORE II were evaluated with regard to severe circulatory failure after operation according to prespecified criteria. To assess what clinical outcomes are indicated by NT-proBNP levels in different risk categories, the patients were stratified according to EuroSCORE II. Based on receiver operating characteristics analysis, these cohorts were assessed with regard to preoperative NT-proBNP below or above 1028 ng litre(-1). The follow-up time averaged 4.4 (0.7) yr.

    Results: Preoperative NT-proBNP >= 1028 ng litre(-1) [odds ratio (OR) 9.9,95% confidence interval (CI) 1.01-98.9; P=0.049] and EuroSCORE II (OR 1.24, 95% CI 1.06-1.46; P=0.008) independently predicted severe circulatory failure after operation. In intermediate-risk patients (EuroSCORE II 2.0-10.0), NT-proBNP >= 1028 ng litre(-1) was associated with a higher incidence of severe circulatory failure (6.6% vs 0%; P=0.007), renal failure (14.8% vs 5.4%; P=0.03), stroke (6.6% vs 0.7%; P=0.03), longer intensive care unit stay [37 (35) vs 27 (38) h; P=0.002], and worse long-term survival.

    Conclusions: Combining EuroSCORE II and preoperative NT-proBNP appears to improve risk prediction with regard to severe circulatory failure after isolated CABG for ACS. NT-proBNP may be particularly useful in patients at intermediate risk according to EuroSCORE II.

  • 7.
    Jaensson, Maria
    et al.
    Örebro University, School of Health Sciences.
    Dahlberg, Karuna
    Örebro University, School of Health Sciences.
    Eriksson, Mats
    Örebro University, School of Health Sciences.
    Nilsson, Ulrica
    Örebro University, School of Health Sciences.
    Evaluation of postoperative recovery in day surgery patients using a mobile phone application: a multicentre randomized trial2017In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 119, no 5, p. 1030-1038Article in journal (Refereed)
    Abstract [en]

    Background: Many patients undergoing anaesthesia and surgery experience postoperative complications. Our aim was to investigate whether a systematic follow-up smartphone-based assessment, using recovery assessment by phone points (RAPP) compared with standard care, had a positive effect on day surgery patients' postoperative recovery. We also investigated whether there were differences in women and men's recovery and recovery scores.

    Methods: The study was a single-blind, multicentre randomized controlled trial. A total of 997 patients were randomly allocated to either RAPP or standard care. The Swedish web version of a quality of recovery (SwQoR) questionnaire was used to evaluate the patients' postoperative recovery, either on paper or using an application (RAPP) on postoperative days seven and 14.

    Results: On postoperative day seven the RAPP group reported significantly better values in seven out of 24 items of the SwQoR: sleeping difficulties; not having a general feeling of wellbeing; having difficulty feeling relaxed/comfortable; and dizziness; headache; pain in the surgical wound; and a swollen surgical wound compared with the control group, implying a good postoperative recovery. Both men and women in the RAPP group reported significantly better values (and, hence good postoperative recovery) compared with the control group in the items sleeping difficulties; not having a general feeling of wellbeing and pain in the surgical wound.

    Conclusions: Measurement of patient-reported outcomes using a smartphone-based application was associated with decreased discomfort from several postoperative symptoms. Systematic e-assessment can thereby increase patients' quality of recovery and identify key areas for improvement in perioperative care.

  • 8.
    Kuchalik, Jan
    et al.
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden; Inst Med & Hlth, Örebro University Hospital, Örebro, Sweden.
    Granath, B.
    Dept Orthopaed Surg, Örebro University Hospital, Örebro, Sweden; Inst Med & Hlth, Örebro University Hospital, Örebro, Sweden.
    Ljunggren, A.
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Magnuson, A.
    Clin Epidemiol & Biostat Unit, Örebro University Hospital, Örebro, Sweden.
    Lundin, Anders
    Dept Orthopaed Surg, Örebro University Hospital, Örebro, Sweden.
    Gupta, Anil
    Dept Anaesthesiol & Intens Care, Örebro University Hospital, Örebro, Sweden.
    Postoperative pain relief after total hip arthroplasty: a randomized, double-blind comparison between intrathecal morphine and local infiltration analgesia2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 111, no 5, p. 793-799Article in journal (Refereed)
    Abstract [en]

    Postoperative pain after total hip arthroplasty (THA) can delay mobilization. This was assessed after intrathecal morphine (ITM) compared with local infiltration analgesia (LIA) using a non-inferiority design. Eighty patients were recruited in this randomized, double-blind study. ITM 0.1 mg (Group ITM) or periarticular local anaesthetic (ropivacaine 300 mg)ketorolac 30 mg epinephrine 0.5 mg (total volume 151.5 ml) (Group LIA) were compared. After 24 h, 22 ml of saline (Group ITM) or ropivacaine (150 mg)ketorolac (30 mg)epinephrine (0.1 mg) (Group LIA) were injected via a catheter. After operation, rescue analgesic consumption, pain intensity, and home-readiness were measured. Morphine consumption was equivalent, median difference 0 mg (95 confidence interval 4 to 4.5) between the groups at 024 h. During 2448 h, it was lower in Group LIA (3 mg, 060 mg, median, range) compared with Group ITM (10 mg, 081 mg) (P0.01). Lower pain scores were recorded at rest at 8 h in Group ITM (P0.01), but in Group LIA on standing and mobilization, at 2448 h (P0.01). Paracetamol and tramadol consumption was lower in Group LIA (P0.05 and 0.05, respectively) as was pruritus, nausea, and vomiting (P0.05). Lower pain intensity was recorded early after surgery in ITM group but later, analgesic consumption, pain intensity on mobilization, and side-effects were lower in patients receiving LIA. LIA is a good alternative to ITM in patients undergoing THA.

  • 9. Larsson, J.
    et al.
    Holmström, Inger
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    How excellent anaesthetists perform in the operating theatre: a qualitative study on non-technical skills2013In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 110, no 1, p. 115-121Article in journal (Refereed)
    Abstract [en]

    Background Teaching trainees to become competent professionals who can keep the complex system of anaesthesia safe is important. From a safety point of view, non-technical skills such as smooth cooperation and good communication deserve as much attention as theoretical knowledge and practical skills, which by tradition have dominated training programmes in anaesthesiology. This study aimed to describe the way excellent anaesthetists act in the operating theatre, as seen by experienced anaesthesia nurses.                                                                                                     

    Methods The study had a descriptive and qualitative design. Five focus group interviews with three or four experienced Swedish anaesthesia nurses in each group were conducted. Interviews were analysed by using a qualitative method, looking for common themes.                                                                                                                  

    Results Six themes were found: (A) structured, responsible, and focused way of approaching work tasks; (B) clear and informative, briefing the team about the action plan before induction; (C) humble to the complexity of anaesthesia, admitting own fallibility; (D) patient-centred, having a personal contact with the patient before induction; (D) fluent in practical work without losing overview; and (F) calm and clear in critical situations, being able to change to a strong leading style.                                                                                                                  

    Conclusions Experienced anaesthesia nurses gave nuanced descriptions of how excellent anaesthetists behave and perform. These aspects of the anaesthetist's work often attract too little attention in specialist training, notwithstanding their importance for safety and fluency at work. Creating role models based on studies like the present one could be one way of increasing safety in anaesthesia.   

  • 10.
    Perniola, Andrea
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Fant, F.
    Department of Anesthesiology and Intensive Care, Örebro University Hospital.
    Magnuson, Anders
    Axelsson, Kjell
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Anesthesiology and Intensive Care, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Gupta, Anil
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Anesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
    Postoperative pain after abdominal hysterectomy: a randomized, doubleblind,controlled trial comparing continuous infusion vs. patient-controlled intraperitoneal injection of local anesthetic2014In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 112, no 2, p. 328-336Article in journal (Refereed)
    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.

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