Continuous infusion of local anaesthetic following laparoscopic hysterectomy—a randomised controlled trial

V Andrews, J T Wright, F Zakaria, S Banerjee, K Ballard
BJOG: An International Journal of Obstetrics and Gynaecology 2014, 121 (6): 754-60; discussion 761

OBJECTIVE: 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.

DESIGN: Double-blind randomised placebo-controlled trial.

SETTING: District general hospital in the UK.

POPULATION: Women undergoing a laparoscopic hysterectomy for a benign indication.

METHODS: 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.

MAIN OUTCOME MEASURES: 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.

RESULTS: Sixty women participated and completed the trial. There was no difference (P = 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 (P = 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.

CONCLUSIONS: Continuous infusion of 0.5% levobupivicaine into the peritoneal cavity following laparoscopic hysterectomy does not have any opioid-sparing effects.

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