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Paper Information

Journal:   MEDICAL JOURNAL OF THE ISLAMIC REPUBLIC OF IRAN (MJIRI)   SPRING 2006 , Volume 20 , Number 1; Page(s) 19 To 22.
 
Paper: 

INTRAPERITONEAL AND INCISIONAL BUPIVACAINE ANALGESIA FOR MAJOR ABDOMINAL/GYNECOLOGIC SURGERY: A PLACEBO CONTROLLED TRIAL

 
 
Author(s):  ATASHKHOUEI S.*, AZAR FARIN R., JAFARI SHOBEIRI M.
 
* DEPTS. OF ANESTHESIOLOGY, TABRIZ UNIVERSITY OF MEDICAL SCIENCES, TABRIZ, I.R. IRAN
 
Abstract: 

Background: Postoperative pain is an important surgical problem. Recent studies in pain pathophysiology have led to the hypothesis that with perioperative administration of analgesics (pre-emptive analgesia) it may be possible to prevent or reduce postoperative pain. This study was planned to investigate the efficacy of preemptive analgesia on postoperative pain after major gynecologic abdominal surgeries.
Methods: In this prospective, double-blinded, randomized, and placebo-controlled trial, 60 ASA physical status I and II patients undergoing major abdominal gynecologic surgeries were randomized to receive 45 mL of bupivacaine 0.375% or 45mL of normal saline; 30 mL and 15 mL of the treatment solution was administered into the peritoneal cavity and incision, respectively, before wound closure. The pain score of the patients was evaluated by the visual analogue scale CV AS) on awakening, and at 6, 12, and 24h after surgery. Time to first analgesia request and total analgesic requirements in the first 24h were recorded.
Results: Pain scores were significantly higher in the placebo group than in the bupivacaine group on awakening (5.9
±1.01 v.S 1.05±1.05; p<0.001), and at 6h after surgery (5.37±0.85 vs. 2.5±1.02; p<0.001). First request to analgesia was significantly longer in the bupivacaine patients than in the placebo group (5.87±3.04 h vs. 1.35±0.36; p<0.001). Meperidine consumptionover24h was 96.00±17.53 mg in the placebo group compared with 23.28±4.89 mg in the bupivacaine patients (p<0.001).
Conclusion: A combination of intraperitoneal and incisional bupivacaine infiltration at the end of abdominal gynecologic surgeries reduces postoperative pain on awakening and for 6 hours after surgery, and provides significant opioid-sparing analgesia for 24h after gynecologic abdominal surgeries.

 
Keyword(s): GYNECOLOGIC ABDOMINAL SURGERIES, PRE-EMPTIVE ANALGESIA, INTRAPERITONEAL INFILTRATION, BUPIVACAINE
 
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