The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy

To assess the effect of local anesthetic wound instillation on visceral and somatic pain, we studied 36 patients undergoing total abdominal hysterecto my and bilateral salpingo-oophorectomy. A standard general anesthetic was a dministered. On completion of the operation, a multiorifice 20-gauge epidur al catheter was placed above the superficial abdominal fascia such that the tip was at the midpoint of the surgical wound. After surgery, either bupiv acaine 0.25% (Bupivacaine group) or sterile water (Control group) was admin istered via a patient-controlled analgesia device programmed to deliver 9.0 mL with a 60-min lockout interval. During the first 6 h after surgery, res cue IV morphine (2 mg) was administered every 10 min until a visual analog scale score of <30 mm was achieved, Thereafter, on patient request, rescue meperidine 1 mg/kg IM was administered. When compared with the Control grou p, significantly (P < 0.001) less rescue analgesia was administered to pati ents in the Bupivacaine group. Rescue morphine administered during the firs t 6 h after surgery was 6 +/- 4 mg versus 12 +/- 6 mg (P < 0.001) for the B upivacaine and Control groups, respectively. Rescue meperidine administered was 29 +/- 37 mg versus 95 +/- 36 mg (P < 0.001) for the Bupivacaine and C ontrol groups, respectively. Nausea and antiemetic drug administration was significantly (P = 0.003) less in the Bupivacaine group. Pain scores were s imilar between the groups. Patient satisfaction was significantly (P = 0.04 ) more in the Bupivacaine group. We conclude that bupivacaine wound instill ation decreases opioid requirements and nausea in the first 24 h after tota l abdominal hysterectomy with bilateral salpingo-oophorectomy.