ROLE OF LOCAL INFILTRATION OF INJECTION BUPIVACAINE IN REDUCING EARLY POST-OPERATIVE PAIN

Mudassar Jabeen Mudassar Jabeen,Muhammad Sohail Muhammad Sohail,Sumara Tabassam Sumara Tabassam,Fawad Zafar Fawad Zafar,Farhad Alam Farhad Alam

doi:10.37723/jumdc.v11i1.306

Abstract

ABSTRACT: BACKGROUND & OBJECTIVE: Intolerable morbidity occurs after major thoracic, orthopedic or abdominal surgeries due to post-operative pain. Inadequately controlled pain leads to patient displeasure and major morbidities like postoperative pulmonary dysfunctions and cardiac ischemic changes. Various techniques are presently used to treat this pain and opiods are the most regularly used medications by parenteral or neuraxial route. Intolerable morbidity occurs post-operatively due to inadequately controlled pain. The objective of this study was to compare the mean pain scores in patients undergoing laparotomy with and without local inﬁltration of injection bupivacaine at surgical incision site in post-operative period. METHODOLOGY: This randomized controlled trial was conducted at surgical department Allied hospital Faisalabad from June 2017 to December 2017.Total 80 patient were included in this study that were randomly divided into two groups using random number tables. In post-operative period, patients of both groups were given treatment as per requirement of their respective diseases. They received a baseline analgesia using Inj. Toradol (ketorolac) 30mg/1ml intravenously every 8 hours, ﬁrst dose given during the surgery. The study group was additionally given 10ml Inj. Bupivacaine HCl 0.5% diluted with 10ml saline injected into the subcutaneous plane around the incision immediately after the closure of skin and time was noted. No further diﬀerence in the treatment of patients of both groups required for the purpose of this study. The patients in both groups were compared for the degree of pain experienced by them in early post-operative period. This information was collected using Numeric pain scale, 10 being worst pain and 1 meaning least appreciable pain. These assessments were done 2 and 4 hours after surgery. RESULTS: We recorded pain score 3.0+0.75 in study and 5.2+0.72 in control group, p-value was < 0.001 showing a signiﬁcant diﬀerence. CONCLUSION: We concluded that there is signiﬁcantly lower pain in patients inﬁltrated with injection bupivacaine around surgical incision in early post-operative period as compared to those who had only intravenous analgesics.

Highlights

Midline abdominal incisions cater a number of benefits for the surgeon but one draw-back is significant pain in post-operative phase[1].This pain is one of the most important factors in limiting early mobilization of patient, increasing requirement for post-operative analgesics and respiratory tract complications, eventually decreasing the rate of recovery[1]
Age distribution of the patients revealed that 52.5% (n=21) in study and 57.5%(n=23) in control group were between 25-40 years of age whereas 47.5%(n=19) in study and 42.5%(n=23) in control group were between 41-65 years of age
Mean BMI of the patients was recorded as 31.24+4.74 in study and 32.41+3.67 in control group. (Table-I) Diagnosis leading to laparotomy categorized as 47.5%(n=19) in study and 55%(n=22) in control group had abdominal trauma. 30%(n=12)in study and25% (n=10)in control group had small intestinal perforation whereas 22.5%(n=9) in study and 20%(n=8) in control group had abdominal infection

Summary

Introduction

Midline abdominal incisions cater a number of benefits for the surgeon but one draw-back is significant pain in post-operative phase[1].This pain is one of the most important factors in limiting early mobilization of patient, increasing requirement for post-operative analgesics and respiratory tract complications, eventually decreasing the rate of recovery[1]. One of the newer methods is injecting a long acting local anesthetic like bupivacaine in the skin around the surgical incision[2] This blocks pain signals originating at the cut edges of the skin from reaching higher centers thereby reducing the morbidity caused by pain. According to Monsef, et al[4] these effects are most pronounced at 2 and 4 hours interval after bupivacaine infusion, the effects gradually receding and becoming statistically insignificant from 6 hours onwards These differences resulted in early mobilization, reduced requirement of post-operative analgesics, reduced overall morbidity and early discharge of the patient[2,4,6]. The objective of this study was to compare the mean pain scores in patients undergoing laparotomy with and without local infiltration of injection bupivacaine at surgical incision site in post-operative period.

Objectives

Methods

Results

Conclusion