A QUALITATIVE SYSTEMATIC REVIEW OF INCISIONAL LOCAL-ANESTHESIA FOR POSTOPERATIVE PAIN RELIEF AFTER ABDOMINAL OPERATIONS

In a qualitative systematic review, we have evaluated randomized contr olled trials (RCT) of incisional local anaesthesia compared with place bo or no treatment in the control of postoperative pain after open abd ominal operations. Twenty six studies with data from 1211 patients wer e considered appropriate for analysis. Five RCT considered inguinal he rniotomy, four hysterectomy, eight cholecystectomy and nine studies a variety of surgical procedures. Outcome measures were pain scores, sup plementary analgesics and time to first analgesic request. Efficacy wa s estimated by significant difference (P<0.05), as reported in the ori ginal investigation. All studies of herniotomy showed a 2-7-h duration of clinically relevant improved pain relief. Results of hysterectomy studies were inconclusive, with two being negative. Five of the cholec ystectomy studies showed significant differences but questionable clin ical importance and validity in three. In various other procedures res ults were inconsistent and in some of minor clinical importance. Excep t for herniotomy, there was a lack of evidence for effect of incisiona l local anaesthesia on postoperative pain and further standardized stu dies are needed before recommendations can be made.