INTRAPERITONEAL AND INCISIONAL BUPIVACAINE ANALGESIA FOR MAJOR ABDOMINAL/GYNECOLOGIC SURGERY: A PLACEBO CONTROLLED TRIAL

Background: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with periopera-tive administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of pre-emptive analgesia on postoperative pain after major gyneco-logic abdominal surgeries. Methods: In this prospective, double-blinded, randomized, and placebo-controlled trial, 60 ASA physical status I and II patients undergoing major abdomi-nal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound clo-sure. The pain score of the patients was evaluated by the visual analogue scale (VAS) on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia re-quest and total analgesic requirements in the first 24h were recorded. Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.98±1.01 v.s 1.05±1.05; p<0.001), and at 6h after surgery (5.37±0.85 vs. 2.51±1.02; p<0.001). First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs. 1.35±0.36; p<0.001). Meperidine consumption over 24h was 96.00 ±17.53 mg in the placebo group compared with 23.28 ±14.89 mg in the bupivacaine patients (p<0.001). Conclusion: A combination of intraperitoneal and incisional bupivacaine in-filtration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioid-sparing analgesia for 24 h after gynecologic abdominal surgeries.