Wound Infiltration With Extended-Release Versus Short-Acting Bupivacaine Before Laparoscopic Hysterectomy: A Randomized Controlled Trial

详细信息    查看全文

• 作者：Kenneth I. Barron ; MD^a ; ^{kenneth.barron.md@gmail.com} ; Georgine M. Lamvu ; MD ; MPH^c ; ^d ; R. Cole Schmidt ; BS^b ; ^c ; Matthew Fisk ; MD^b ; ^c ; Emily Blanton ; MD^b ; ^c ; Insiyyah Patanwala ; MD^b ; ^c
• 关键词：Hysterectomy ; Laparoscopy ; Local anesthesia ; Postoperative pain ; Robotics
• 刊名：Journal of Minimally Invasive Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：24
• 期：2
• 页码：286-292
• 全文大小：644 K
• 卷排序：24

文摘

To evaluate if preincision infiltration with extended-release liposomal bupivacaine provides improved overall pain relief compared with 0.25% bupivacaine after laparoscopic or robotic-assisted hysterectomy.DesignA single-center double-masked randomized controlled trial (Canadian Task Force Classification I).SettingA tertiary-care community hospital.PatientsPatients recruited from July 2015 through January 2016. Sixty-four patients were randomized, and 59 were analyzed for the primary outcome.InterventionsWomen scheduled to undergo multiport laparoscopic or robotic-assisted total hysterectomy for benign indications were randomized to receive preincision infiltration with undiluted liposomal bupivacaine or 0.25% bupivacaine.Measurements and Main ResultsThe primary outcome was overall average pain intensity by numeric rating scale (0–10) using the Brief Pain Inventory (BPI) via telephone survey on postoperative day (POD) 3. A sample size of 28 per group (N = 56) was planned to detect a 30% change in pain scores. Secondary outcomes were overall average and worst numeric pain scores on PODs 1, 2, and 14; pain scores in hospital; BPI pain interference scores; and total opioid use. There were no demographic differences between the 2 groups. For the primary outcome, we found a decrease in the average (p = .02) pain scores on POD 3 in the liposomal bupivacaine group. We also found a decrease in worst pain scores on POD 2 (p = .03) and POD 3 (p = .01). There were no differences in pain scores while in the hospital or on POD 1 or POD 14. There were no differences in BPI pain interference scores, opioid use, or reported adverse effects.ConclusionFor laparoscopic and robotic-assisted multiport hysterectomies, there is evidence of decreased average postoperative pain with liposomal bupivacaine compared with 0.25% bupivacaine for port-site analgesia on POD 3, but no difference in opioid use or measures of functioning.