Randomized clinical trial of local bupivacaine perfusion versus parenteralmorphine infusion for pain relief after laparotomy

Background: Opioids are often used to decrease pain following laparotomy bu t are associated with unwanted side-effects. The effectiveness of local per fusion of bupivacaine 0.5 per cent following laparotomy was studied. Methods: A prospective randomized study involving patients undergoing lapar otomy for major colorectal surgery using a left iliac fossa skin crease inc ision was undertaken. Patients were randomized to receive either intermitte nt intravenous morphine infusion on demand with patient-controlled analgesi a (PCA group) or continuous wound perfusion of local bupivacaine 0.5 per ce nt for 60 h (LA group). Results: Seventy patients were recruited, 35 in each group. Patient demogra phics, surgical and recovery variables and complications were comparable in the two groups. The wound lengths were similar (median 14 cm in both group s). There was no statistically significant difference in postoperative pain scores at rest and with movement between the two groups, except for pain s cores at rest on the first postoperative day (P = 0.03). The median total a mount of morphine used was significantly greater in the PCA group (median 3 8 versus 0 mg in the LA group; P < 0.001). Conclusion: Direct continuous local wound perfusion of bupivacaine 0.5 per cent is as effective as PCA for postoperative pain relief after laparotomy. It is a safe and feasible alternative to parenteral opioids.