EFFECT OF PREINCISION VERSUS POSTINCISION INFILTRATION WITH BUPIVACAINE ON POSTOPERATIVE PAIN

Study Objective: To compare the efficacy of preincision wound infiltra tion with bupivacaine to wound infiltration at the end of the operatio n. Design: A prospective, randomized, double-blind study. Setting: Uni versity medical center. Patients: 56 ASA status I and II women schedul ed for abdominal hysterectomy were randomly assigned to one of three t reatment groups. Interventions: Group 1 (control) received no local an esthetic infiltration. Group 2 received subcutaneous infiltration with 40 mi of bupivacaine 0.5% (pH 6.9) 15 minutes prior to incision. Grou p 3 received wound infiltration with a similar solution at the end of surgery. Anesthesia was induced with thiopental 3.0 mg/kg IV, droperid ol 50 mu g/kg IV, and sufentanil 0.5 mu g/kg IV, and maintained with n itrous oxide 67% in oxygen and sufentanil 0.1 mu g/kg IV boluses as re quired. Postoperative pain was treated with morphine via a patient-con trolled analgesia delivery system for 24 hours, followed by oral hydro codone for 3 days. Measurements and Main Results: The opioid consumpti on was recorded for 4 days postoperatively. Pain scores were measured at 4 to 8-hour intervals using 100 mm visual analog scales. There was no difference in either the opioid analgesic requirements or the pain scores between the three study groups. Conclusions: Wound infiltration , either preincision or postincision, had no clinically significant ef fect on the pain scores or analgesic requirements following abdominal hysterectomy.