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

Journal article
Authors Jane M. Hayden
Jonatan Oras
O. Karlsson
K. G. Olausson
Sven Egron Thörn
A. Gupta
Published in Acta Anaesthesiologica Scandinavica
Volume 61
Issue 5
Pages 539-548
ISSN 0001-5172
Publication year 2017
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 539-548
Language en
Links doi.org/10.1111/aas.12883
Keywords patient-controlled analgesia, intrathecal morphine, continuous-infusion, controlled-trial, plane block, intraperitoneal, anesthetics, management, surgery, placebo
Subject categories Orthopedics

Abstract

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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