Lack of postoperative pain relief after hysterectomy using preperitoneallyadministered bupivacaine

Background and Objectives. It is well known that wound infiltration with lo cal anesthetic can reduce postoperative pain in various degrees and with ve ry few side effects. A previous study showed better analgesic effect when l ocal anesthetic was applied in the subfascial, rather than the subcutaneous , layer. The present study investigated the effect of frequent bolus inject ions of bupivacaine ( 15 mt 2.5 mg/mL) preperitoneally through catheters pl aced intraoperatively in women who had undergone hysterectomy. Methods. Pos toperative pain and analgesic requirements were studied in a double-blind r andomized trial including 41 patients. During surgery, the patients were ra ndomized to one of two groups, and the investigators were blinded. Prior to closure of the peritoneum, the surgeon placed a catheter between the muscl e layer and the peritoneum on each side of the wound. One group (n = 22) re ceived bupivacaine (15 mt 2.5 mg/mL) every 4 hours for 48 hours via each ca theter starting in the operating room. The placebo group (n = 19) received saline in a like manner. Postoperative pain was evaluated using. a visual a nalog scale (VAS) and verbal rating scale (VRS) twice a day for 2 days at r est and on movement. Requirements of supplementary analgesics were monitore d, as was wound infection alter discharge. Results. Bupivacaine administere d preperitoneally did nut improve analgesia at rest, during coughing, or du ring mobilization compared with saline. No difference between the groups wa s found regarding analgesic requirements. No complications of postoperative wound healing or toxic side effects were seen. Conclusion. Bolus injection s of bupivacaine through intraoperative placed catheters did not improve an algesia postoperatively compared with saline injections.