Cc. Leung et al., Effect of pre-incision skin infiltration on post-hysterectomy pain - A double-blind randomized controlled trial, ANAESTH I C, 28(5), 2000, pp. 510-516
In this double-blind placebo-controlled randomized trial, we compared the a
nalgesic effect of preoperative 0.25% bupivacaine (n=21) skin infiltration
with normal saline (n=19) in patients undergoing abdominal hysterectomy thr
ough a lower midline incision. All patients received postoperative patient-
controlled analgesia with morphine and were followed for 72 hours. The main
outcome measures were morphine consumption and pain score at rest, and the
contribution of different components of pain was also assessed prospective
ly. No statistically significant differences were found. All except one pat
ient (n =39) could distinguish the different characteristics of somatic and
visceral pain. Visceral pain predominated in the first 48 hours. We conclu
ded that local anaesthetic infiltration is not effective in reducing pain a
fter abdominal hysterectomy. Effective postoperative analgesia should aim t
o eliminate the visceral pain component.