Ostalo

Continuous wound infusion of levobupivacaine after total abdominal hysterectomy with bilateral salpingo-oophorectomy

STELA MARIĆ ; University Hospital for Tumors, Anesthesiology and Intensive Care, Zagreb, Croatia
MIROSLAV BANOVIĆ ; University Hospital for Tumors, Anesthesiology and Intensive Care, Zagreb, Croatia
KATA ŠAKIĆ ZDRAVČEVIĆ ; University Hospital Center Zagreb, Anesthesiology and Intensive Care, Zagreb, Croatia
DUBRAVKA BARTOLEK ; University Hospital of Traumatology, Anesthesiology and Intensive Care, Zagreb, Croatia
LJILJANA ŠTEFANČIĆ ; University Hospital for Tumors, Anesthesiology and Intensive Care, Zagreb, Croatia
DUBRAVKA KRLEŽA SUPIĆ ; University Hospital for Tumors, Anesthesiology and Intensive Care, Zagreb, Croatia

Sažetak

Background and Purpose: Blockade of nociceptive afferents by the use of continuous wound infiltration with local anesthetics may be beneficial in a postoperative multimodal pain management after total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO). The role of continuous wound infusion of levobupivacaine for pain relief and postoperative recovery was evaluated.

Materials and Methods: Fifty female patients (ASA I-III) scheduled
for TAH and BSO were divided in two equal groups during prospective, double-blinded, placebo-controlled trial. On completion of the operation, a multiorifice 20-gauge epidural catheter was placed above the superficial abdominal fascia. Patients were randomly assigned to receive through the catheter 0.25% levobupivacaine (Group L) with 6ml bolus followed by an infusion of 7 ml/h during 48 h, or the same protocol with 0.9% NaCl (Group S). Simultaneously, patient-controlled analgesia provided intravenous morphine.
All patients also received diclofenac 75 mg every 12 h for 48 h.

Results and Conclusions: Median Visual Analogue Scale (VAS) was
satisfactory. Compared with suprafascial saline, levobupivacaine infusion reduced morphine consumption during the first 48 h. The morphine consumption was significantly less (P<0.001) in Group L (6.91 +/– 3.17 mg) in comparison to Group S (50.61 +/– 14.02 mg). Nausea was less in Group L. Time to recover the bowel function was significantly reduced in Group L. No side effects were observed. Postoperative pain control with continuous wound infusion of 0.25% levobupivacaine after TAH with BSO provides effective analgesia, decreases opioid requirements and reduces time to recover the bowel function.

Ključne riječi

continuous wound infusion analgesia; levobupivacaine: opioid analgesia, morphine, hysterectomy

Hrčak ID:

38261

URI

https://hrcak.srce.hr/38261

Datum izdavanja:

15.6.2009.

Posjeta: 2.180 *