Preoperative infiltration of the surgical area enhances postoperative analgesia of a combined low–dose epidural bupivacaine and morphine regimen after upper abdominal surgery

Abstract

In a randomized, blinded trial we assessed the value of adding preoperative infiltration of the surgical area with bupivacaine to a low dose epidural regimen for postoperative pain treatment. Forty-nine patients scheduled for major upper abdominal surgery during combined thoracic epidural (bupivacaine + morphine) and general anaesthesia were studied. Postoperative analgesia was epidural bupivacaine 10 mg/hr-1 + morphine 0.2 mg/hr-1 for 72 h. The patients randomly received preoperative infiltration of the surgical area with bupivacaine 0.25%, 40 ml (group I); or no infiltration (group II). Pain was evaluated at rest, during cough and during mobilization six and eight h after start of surgery, and at 8 a.m. and 4 p.m. on the following days until 72 h after start of surgery. The sensory level of analgesia was evaluated by pin prick. We found no difference between the two groups during rest and cough. However, during mobilization group I had lower pain scores compared to group II (P < 0.05). There was a significant reduction in the need for supplemental intramuscular morphine in the treatment group compared to the control group (P < 0.05). Thus an enhanced analgesic effect was demonstrated by adding preoperative infiltration of the surgical area with local anaesthetic to a low dose epidural bupivacaine/morphine regimen after upper abdominal surgery.

A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations

“…(table 4). [27][28][29][30][31][32][33][34][35] In the three studies on Caesarean section, 27-29 0.25% or 0.5% bupivacaine 20 ml caused a 20-50% reduction in analgesic consumption. [27][28][29] However, this effect lasted for only 4 h. Furthermore, in only one study 28 were pain scores reduced compared with control.…”

Altered hematologic profiles following donor right hepatectomy and implications for perioperative analgesic management

“…3,4,[7][8][9][10][11] Hence, development of an optimal perioperative pain management strategy for donors is a complex clinical challenge. Although epidural pain management has been recommended, 12 and used successfully in living liver donor surgery, 8,9,12 a systematic assessment of its efficacy and safety in living donors for adult liver transplantation, who typically donate approximately 60% of their liver, 13,14 is not available.Reports in operations other than liver donation suggest that epidural pain management, in combination with local anesthetic field infiltration, offers effective, opioid-sparing analgesia [15][16][17] as an alternative to systemic opioids with their potential hepatotoxicity 18,19 and risk of sedation. In the current case series, we evaluated the efficacy and safety of this 2-site approach and assessed postoperative changes in liver function tests and coagulation.…”

“…Reports in operations other than liver donation suggest that epidural pain management, in combination with local anesthetic field infiltration, offers effective, opioid-sparing analgesia [15][16][17] as an alternative to systemic opioids with their potential hepatotoxicity 18,19 and risk of sedation. In the current case series, we evaluated the efficacy and safety of this 2-site approach and assessed postoperative changes in liver function tests and coagulation.…”

Current treatment options for acute pain

“…Local infiltration conveys some benefit during herniorrhaphy [102,105] but has led to equivocal results for other types of abdominal incision [139][140][141]. However, pre-emptive use of local anaesthetic at the incision sites [142] or topically on the peritoneum [143] during laparoscopic procedures has been beneficial.…”