IS WOUND INFILTRATION WITH ANESTHETIC EFFECTIVE AS PREEMPTIVE ANALGESIA - A CLINICAL-TRIAL IN APPENDECTOMY PATIENTS

OBJECTIVE: To assess the efficacy of wound infiltration with local ane sthetic in reducing postoperative pain after a muscle-splitting incisi on for appendectomy. DESIGN: A double-blind, placebo-controlled, rando mized clinical trial. SETTING: The Royal Columbian Hospital, a univers ity-affiliated community hospital. PARTICIPANTS: Forty-three patients scheduled to undergo emergency appendectomy were randomized into treat ment (21) and control (22) groups: Five patients were excluded from th e treatment group. INTERVENTIONS: Local anesthetic infiltration of the wound before incision (treatment group) and saline infiltration (cont rol group). MAIN OUTCOME MEASURES: Postoperative analgesic requirement s, pain assessment by visual analogue scale and length of hospital sta y. RESULTS: No significant difference in analgesic use was seen betwee n the 2 groups, as measured at 3 stages (M-c = control mean [standard deviation], M-c = treatment mean [standard deviation]): (a) in the rec overy room, intravenous morphine use was M-c = 6.6 mg [8.6] v. M-c = 1 0.1 mg [7.2]; (6) in the first 2 postoperative days, intramuscular mep eridine use was M-c = 309 mg [181] v. M-c = 278 mg [125] on day 1 and was M-c = 121 mg [132] v. M-c = 97 mg [128] on day 2; (c) in the final 5 daps of follow-up, oral analgesic use was M-c = 11 [17] tablets v. M-c = 21 [16] tablets (acetaminophen with codeine). Pain assessments a t rest, on a scale of 1 to 10, were found to be no different between g roups, ratings being M-c = 4.7 [2.1] v. M-c = 4.5 [2.0] on day 1. Leng th of hospital stay averaged 3.0 days in both groups. CONCLUSION: Infi ltration with local anesthetic before incision does not pre-empt posto perative pain from a muscle-splitting incision used for appendectomy.