Intraperitoneal bupivacaine or lidocaine does not provide analgesia after total abdominal hysterectomy

Abstract

We have compared pain scores at rest and on standardized movement, and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy. Patients were allocated randomly to one of three groups: in the saline group, 0.9% sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum; in the second group, the solution administered was 20 ml of 0.5% bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml; in the third group, the solution used was 20 ml [corrected] of 2% lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml. We found that there was no significant difference between the three groups in visual analogue pain scores at 8, 12, 36 or 48 h after operation at rest or on movement, and no significant difference in sedation or dose of antiemetic administered. Mean morphine consumption in the first 24 h was 54.6 (SEM 5.9) mg in the saline group, 55.5 (6.4) mg in the bupivacaine group and 52.5 (5.3) mg in the lidocaine group. In the second 24 h, morphine consumption was 34.9 (6.6) mg, 28.1 (3.5) mg and 28.0 (3.5) mg in the three groups, respectively. We conclude that i.p. administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy.

Intraperitoneal Ropivacaine for Effective Pain Relief after Laparoscopic Appendectomy: A Prospective, Randomized, Double-blind, Placebo-controlled Study

“…In gynaecology, Ali et al 16 found that intraperitoneal delivery of 100 mg 0.5% bupivacaine did not reduce pain in patients undergoing abdominal hysterectomy, whereas Narchi et al 17 reported a decrease in pain after the administration of 100 mg 0.125% bupivacaine.…”

Local Anesthetic Administration Into Uterine Ligaments or Pelvic Cavity to Attenuate Surgical Stress Response During Abdominal Hysterectomy

“…The ef fects of in tra pe ri to ne al lo cal anesthe tic in fil tra ti on in hyste rec to mi es ha ve be en re por ted, ho we ver the chan ges in the he art ra te and blo od pres su re va lu es ha ve not be en de ter mined. 14,15 Pa in sco res (NS) we re the hig hest in the control gro up, but the different was not sta tis ti cally significant. We ad mi nis te red me pe ri di ne to all pati ents for pos to pe ra ti ve anal ge si a.…”

“…The nor ma lity of the da ta dis tri bu ti on was tes ted with Sha pi ro-Wilk test. Be ca u se the dis tri bu ti ons of re pe a ted me a su re ment we re nor mal; by using preo pe ra ti ve (pre-in duc ti on) da ta co-va ri ant, co-va rian ce analy ses (AN CO VA) was used to com pa re se cond (at the 5 th mi nu te af ter the ute ri ne ex ci sion) and third (15 th mi nu te af ter ex tu ba ti on) me asu re ments. Post-hoc Tu key test was used for bi nary com pa ri son.…”

Evidence-Based Anesthesia for Major Gynecologic Surgery

“…74,75 However, a meta-analysis has confirmed the analgesic efficacy of continuous infusion of intraperitoneal local anesthetics. 76 Up to 40% opioid-sparing effects were reported with this technique after open abdominal hysterectomy, 77 with better efficacy using a patient-controlled technique compared with a continuous infusion.…”