Continuous infusion of local anaesthetic following laparoscopic hysterectomy—a randomised controlled trial. (19th February 2014)

• Record Type: Journal Article
• Authors: Andrews, V; Wright, JT; Zakaria, F; Banerjee, S; Ballard, K
• Is Part Of: BJOG. Volume 121:Number 6(2014:Jun.)
• Page Start: 754
• Page End: 760
• Publication Date: 2014-02-19
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12610
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12610-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12610-sec-0001" sec-type="section"> <title>Objective</title> <p>To estimate whether a continuous infusion of intraperitoneal local anaesthetic for 48 hours following laparoscopic hysterectomy reduced the need for opioids delivered with a patient‐controlled analgesia pump.</p> </sec> <sec id="bjo12610-sec-0002" sec-type="section"> <title>Design</title> <p>Double‐blind randomised placebo‐controlled trial.</p> </sec> <sec id="bjo12610-sec-0003" sec-type="section"> <title>Setting</title> <p>District general hospital in the UK.</p> </sec> <sec id="bjo12610-sec-0004" sec-type="section"> <title>Population</title> <p>Women undergoing a laparoscopic hysterectomy for a benign indication.</p> </sec> <sec id="bjo12610-sec-0005" sec-type="section"> <title>Methods</title> <p>Women were randomised to receive either 0.5% levobupivicaine or 0.9% normal saline via an ON‐Q elastomeric pump for 48 hours postoperatively. The amount of opioids used via the patient‐controlled analgesia pump was recorded and pain was measured using an 11‐point Box Scale.</p> </sec> <sec id="bjo12610-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>The primary outcome was the amount of patient‐administered morphine used over the first 48 postoperative hours. Secondary outcomes were length of hospital stay, oral analgesia use and level of patient‐reported pain.</p> </sec> <sec id="bjo12610-sec-0007" sec-type="section"> <title>Results</title> <p>Sixty women participated and completed the trial. There was no difference (<italic>P </italic>= 0.59) in the median amount of patient‐administered morphine used between the levobupivicaine (23 mg) and placebo (18.5 mg) groups; median group difference 3.0 (95% CI −7.0 to 14.0). There was also no difference in the length of hospital stay with 40% of the treatment group remaining in hospital >48 hours compared with 30% of the placebo group (<italic>P </italic>= 0.08). Pain scores at all postoperative time points remained similar, with a median group difference in pain scores of 1.0 (95% CI −1.0 to 2.0) at the end of the first postoperative day.</p> </sec> <sec id="bjo12610-sec-0008" sec-type="section"> <title>Conclusions</title> <p>Continuous infusion of 0.5% levobupivicaine into the peritoneal cavity following laparoscopic hysterectomy does not have any opioid‐sparing effects.</p> </sec> </abstract>