Wound instillation with 0.25% bupivacaine as continuous infusion following hysterectomy
Gupta, S.; Maheshwari, R.; Dulara, S.Chandra.
Middle East Journal of Anaesthesiology 18(3): 595-610
2005
ISSN/ISBN: 0544-0440 PMID: 16381265 Document Number: 591291
Postoperative pain relief was assessed by tile effects of local anesthetic wound instillation oil 100 patients who had Undergone total abdominal hysterectomy with bilateral salpingo oophorectomy (TAH with BSO). Patients were divided into four groups of wound and non-wound instillation:Wound instillation Group A(1) received diclofenac IM.Non-wound instillation Group B-1 received diclofenac IM.Group B-2 received diclofenac suppository.A standard general anesthesia technique was administered. For would instillation, a multiholed (I 1 cm apart) 18G epidural catheter was placed above rectus sheath. This was connected to a pediatric regulated drip set with "Dial-a flo" to deliver 0.25% bupivacaine 10 ml/hour for 6 hours after a basal bolus of 10 ml. During first 6 hours after surgery rescue pentazocine 15 mg was administered to achieve VAS score <= 30. Thereafter, rescue diclofenac was administered to patients. The requirement of rescue analgesic (pentazocine) was significantly less (P<0.001) in wound instillation Groups A(1) (13.80 mg +/- 13.64) and A(2) (1210 mg +/- 12.25) in comparison to non wound instillation Groups B-1 (35.60 mg +/- 14.02) and B-2 (31.80 mg +/- 15.80). Rescue diclofenac was not required in wound instillation groups as compared to 30 mg (B-1) and 36 mg (B-2) in non wound instillation groups.Nausea and vomiting was less in wound instillation groups. VAS score supine from 4(th) to 12(th) hours, VAS coughing during all time interval and VAS leg, raising from 3(rd) to 12(th) hours was significantly lower (P<0.001) in wound installation group Q, AD in comparison to non wound instillation groups (B-1, B-2).We conclude that basal bolus infusion followed by continuous wound instillation of bupivacaine decreases analgesic requirement and pain scores in first 24 hours of postoperative period after TAH with BSO.