A team from the Department of Colorectal Surgery, Singapore General Hospital, Singapore, investigated the effectiveness of local perfusion of bupivacaine following laparotomy.
|Median amount of morphine used after laparotomy:|
Parenteral morphine infusion:
Local bupivacaine perfusion:
|Br J Surg|
A prospective randomized study, involving patients undergoing laparotomy for major colorectal surgery using a left iliac fossa skin crease incision, was undertaken.
Patients were randomized to receive either intermittent intravenous morphine infusion on demand with patient-controlled analgesia (PCA group) or continuous wound perfusion of local bupivacaine 0·5% for 60 hours (LA group).
The researchers recruited 70 patients, 35 in each group. Patient demographics, surgical and recovery variables and complications were comparable in the two groups. The wound lengths were similar (median 14 cm in both groups).
The team found that there was no statistically significant difference in postoperative pain scores at rest and with movement between the two groups, except for pain scores at rest on the first postoperative day.
The median total amount of morphine used was significantly greater in the PCA group (median 38 versus 0 mg in the LA group).
Dr W. K. Cheong concluded on behalf of the group, "Direct continuous local wound perfusion of bupivacaine 0·5% is as effective as PCA for postoperative pain relief after laparotomy.
"It is a safe and feasible alternative to parenteral opioids."