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

• Published in: Acta anaesthesiologica Scandinavica Vol. 61; no. 5; pp. 539 - 548
• Main Authors: Hayden, J. M., Oras, J., Karlsson, O. I., Olausson, K. G., Thörn, S.‐E., Gupta, A.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-05-2017
• Subjects: Amides; Analgesia - methods; Anestesi och intensivvård; Anesthesiology and Intensive Care; Anesthetics, Local - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Double-Blind Method; Female; Humans; Hysterectomy; Injections; Ketorolac - administration & dosage; Medicin och hälsovetenskap; Middle Aged; Pain Management - methods; Pain, Postoperative - drug therapy; Sodium Chloride - administration & dosage; Treatment Outcome
• ISSN: 0001-5172; 1399-6576; 1399-6576
• DOI: 10.1111/aas.12883

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.