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Post-operative pain relief using local infiltration analgesia during open abdominal hysterectomy: a randomized, double-blind study

Artikel i vetenskaplig tidskrift
Författare Jane M. Hayden
Jonatan Oras
O. Karlsson
K. G. Olausson
Sven Egron Thörn
A. Gupta
Publicerad i Acta Anaesthesiologica Scandinavica
Volym 61
Nummer/häfte 5
Sidor 539-548
ISSN 0001-5172
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, sektionen för anestesi, biomaterial och ortopedi. Avdelningen för anestesiologi och intensivvård
Sidor 539-548
Språk English
Länkar doi.org/10.1111/aas.12883
Ämnesord patient-controlled analgesia, intrathecal morphine, continuous-infusion, controlled-trial, plane block, intraperitoneal, anesthetics, management, surgery, placebo
Ämneskategorier Ortopedi

Sammanfattning

Background: Post-operative pain is common and often severe after open abdominal hysterectomy, and analgesic consumption high. This study assessed the efficacy of local infiltration analgesia (LIA) injected systematically into different tissues during surgery compared with saline on post-operative pain and analgesia. Methods: Fifty-nine patients were randomized to Group LIA (n = 29) consisting of 156 ml of a mixture of 0.2% ropivacaine + 30 mg ketorolac + 0.5 mg (5 ml) adrenaline, where the drugs were injected systematically in the operating site, around the proximal vagina, the ligaments, in the fascia and subcutaneously, or to saline and intravenous ketorolac, Group C (Control, n = 28), in a double-blind study. Post-operative pain, analgesic consumption, side-effects, and home discharge were analysed. Results: Median dose of rescue morphine given 0-24 h after surgery was significantly lower in group LIA (18 mg, IQR 5-25 mg) compared with group C (27 mg, IQR 15-43 mg, P = 0.028). Median time to first analgesic injection was significantly longer in group LIA (40 min, IQR 20-60 min) compared with group C (20 min, IQR 12-30 min, P = 0.009). NRS score was lower in the group LIA compared with group C in the direct post-operative period (0-2 h). No differences were found in post-operative side-effects or home discharge between the groups. Discussion: Systematically injected local infiltration analgesia for pain management was superior to saline in the primary endpoint, resulting in significantly lower rescue morphine requirements during 0-24 h, longer time to first analgesic request and lower early post-operative pain intensity.

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