Efficacy of Pre‐incisional Bupivacaine Infiltration on Postoperative Pain Relief after Appendectomy: Prospective Double‐blind Randomized Trial

Abstract

Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre-incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double-blinded study was conducted on 123 patients aged 13-45 years with a preoperative and-postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients' request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower ( p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre-incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.

Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

“…The results in this area are mixed with several studies showing significant pain reduction [11,12,14] while other studies did not find a reduction in pain or had mixed results [10,13,[16][17][18].…”

“…Injecting local anesthetics prior to surgical incision into the surgical wound has been more extensively studied [10][11][12][13][14][15][16]. The results in this area are mixed with several studies showing significant pain reduction [11,12,14] while other studies did not find a reduction in pain or had mixed results [10,13,[16][17][18].…”

The Effect of Local Tramadol Injection in Post Appendectomy Pain

“…Local injection techniques are one of those methods. In this technique, local anesthetics and weak opioids, like tramadol, have been examined [8][9][10][11][12][13]. Tramadol is a medicine with central effect, which has been effective in reduction of moderate and severe pains.…”

Opioid-sparing effect of selective cyclooxygenase-2 inhibitors on surgical outcomes after open colorectal surgery within an enhanced recovery after surgery protocol

“…However, valdecoxib has been off the market since 2005 due to its potentially life-threatening skin reaction and lack of adequate data on its long-term cardiovascular safety [21] . Many studies have shown that preemptive analgesia is more effective than postoperative analgesia [22][23][24] . A combination of preoperative and postoperative admini- stration of analgesics would have a better pain control.…”