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

Abstract

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. Fifty-nine patients were randomized to Group LIA (n=29) consisting of 156ml of a mixture of 0.2% ropivacaine + 30mg ketorolac + 0.5mg (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. Median dose of rescue morphine given 0-24h after surgery was significantly lower in group LIA (18mg, IQR 5-25mg) compared with group C (27mg, IQR 15-43mg, P=0.028). Median time to first analgesic injection was significantly longer in group LIA (40min, IQR 20-60min) compared with group C (20min, IQR 12-30min, P=0.009). NRS score was lower in the group LIA compared with group C in the direct post-operative period (0-2h). No differences were found in post-operative side-effects or home discharge between the groups. Systematically injected local infiltration analgesia for pain management was superior to saline in the primary endpoint, resulting in significantly lower rescue morphine requirements during 0-24h, longer time to first analgesic request and lower early post-operative pain intensity.