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Efficacy of Pre-incisional Bupivacaine Infiltration on Postoperative Pain Relief after Appendectomy: Prospective Double-blind Randomized Trial

Abstract

Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre-incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double-blinded study was conducted on 123 patients aged 13–45 years with a preoperative and-postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients’ request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower (p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre-incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.

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References

  1. A Shafer PF White ML Urquhart et al. (1989) ArticleTitleOutpatient premedication: use of midazolam and opioid analgesics Anesthesiology 71 495–501 Occurrence Handle1:STN:280:By%2BD38vjs1c%3D Occurrence Handle2478048

    CAS  PubMed  Google Scholar 

  2. CG Mixter Suffix3rd TR Hackett (1997) ArticleTitlePreemptive analgesia in the laparoscopic patient Surg. Endosc. 11 351–353 Occurrence Handle10.1007/s004649900361 Occurrence Handle9094275

    Article  PubMed  Google Scholar 

  3. MC Hession (1998) ArticleTitleFactors influencing successful discharge after outpatient laparoscopic cholecystectomy J. Perianesth. Nurs. 13 11–15 Occurrence Handle1:STN:280:DyaK1c3gsFGntQ%3D%3D Occurrence Handle9543965

    CAS  PubMed  Google Scholar 

  4. RW Ke SG Portera W Bagous et al. (1998) ArticleTitleA randomized, double-blinded trial of preemptive analgesia in laparoscopy Obstet. Gynecol. 92 972–975 Occurrence Handle10.1016/S0029-7844(98)00303-2 Occurrence Handle1:STN:280:DyaK1M%2FlsVaqtw%3D%3D Occurrence Handle9840560

    Article  CAS  PubMed  Google Scholar 

  5. M Tversky C Cozacov M Ayache et al. (1990) ArticleTitlePostoperative pain after inguinal herniorrhaphy with different types of anesthesia Anesth. Analg. 70 29–35 Occurrence Handle2297102

    PubMed  Google Scholar 

  6. JA Jebeles JS Reilly JF Gutierrez et al. (1991) ArticleTitleThe effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anesthesia Pain 47 305–308 Occurrence Handle10.1016/0304-3959(91)90220-R Occurrence Handle1:STN:280:By2C2M%2FgslE%3D Occurrence Handle1784501

    Article  CAS  PubMed  Google Scholar 

  7. J Kato S Ogawa J Katz et al. (2000) ArticleTitleEffects of presurgical local infiltration of bupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecologic examination: a possible preemptive analgesic effect Clin. J. Pain 16 12–17 Occurrence Handle10.1097/00002508-200003000-00003 Occurrence Handle1:STN:280:DC%2BD3c3gtlymtQ%3D%3D Occurrence Handle10741813

    Article  CAS  PubMed  Google Scholar 

  8. K Hannibal H Galatius A Hansen et al. (1996) ArticleTitlePreoperative wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy Anesth. Analg. 83 376–381 Occurrence Handle10.1097/00000539-199608000-00030 Occurrence Handle1:CAS:528:DyaK28Xlt1ShsLg%3D Occurrence Handle8694322

    Article  CAS  PubMed  Google Scholar 

  9. HJ McQuay D Carroll RA Moore (1988) ArticleTitlePostoperative orthopaedic pain: the effect of opiate premedication and local anesthetic blocks Pain 33 291–295 Occurrence Handle10.1016/0304-3959(88)90287-4 Occurrence Handle1:STN:280:BieA3srjslY%3D Occurrence Handle3419836

    Article  CAS  PubMed  Google Scholar 

  10. C Woolf (1991) ArticleTitleGeneration of acute pain: central mechanisms Br. Med. Bull. 47 523–533 Occurrence Handle1:STN:280:By2C2szptFU%3D Occurrence Handle1794070

    CAS  PubMed  Google Scholar 

  11. RS Sinatra (1992) Pathophysiology of acute pain RS Sinatra AH Hord B Ginsberg LM Preble (Eds) Acute Pain: Mechanisms & Management Mosby St. Louis 44–57

    Google Scholar 

  12. GA Turner G Chalkiadis (1994) ArticleTitleComparison of preoperative with postoperative lignocaine infiltration on postoperative analgesic requirements Br J Anesth 72 541–543 Occurrence Handle1:STN:280:ByuB2Mjjs1Q%3D

    CAS  Google Scholar 

  13. CY Ko JE Thompson SuffixJr A Alcantara et al. (1997) ArticleTitlePreemptive analgesia in patients undergoing appendectomy Arch. Surg. 132 874–878 Occurrence Handle1:STN:280:ByiH3M3mt1Q%3D Occurrence Handle9267272

    CAS  PubMed  Google Scholar 

  14. P Courreges M Peron F Poddevin et al. (1996) ArticleTitleValue of ilio-hypogastric block in appendectomy in children Can Anesthesiol 44 293–296 Occurrence Handle1:STN:280:ByiC1cnisV0%3D

    CAS  Google Scholar 

  15. P Cervini LC Smith DR Urbach (2002) ArticleTitleThe effect of intraoperative bupivacaine administration on parenteral narcotic use after laparoscopic appendectomy Surg. Endosc. 16 1579–1582 Occurrence Handle10.1007/s00464-002-8803-0 Occurrence Handle1:STN:280:DC%2BD38notlGjsA%3D%3D Occurrence Handle12045850

    Article  CAS  PubMed  Google Scholar 

  16. SA Goodwin (1998) ArticleTitleA review of preemptive analgesia J. Perianesth. Nurs. 13 109–114 Occurrence Handle1:STN:280:DyaK1c3lsVOrug%3D%3D Occurrence Handle9592452

    CAS  PubMed  Google Scholar 

  17. DJ Kelly M Ahmad SJ Brull (2001) ArticleTitlePreemptive analgesia I: physiological pathways and pharmacological modalities Can. J. Anaesth. 48 1000–1010 Occurrence Handle1:STN:280:DC%2BD3MnksFOlug%3D%3D Occurrence Handle11698320

    CAS  PubMed  Google Scholar 

  18. A Gottschalk DS Smith DR Jobes et al. (1998) ArticleTitlePreemptive epidural analgesia and recovery from radical prostatectomy: a randomized controlled trial J. A. M. A. 279 1076–1082 Occurrence Handle10.1001/jama.279.14.1076 Occurrence Handle1:CAS:528:DyaK1cXivVShurc%3D Occurrence Handle9546566

    Article  CAS  PubMed  Google Scholar 

  19. GJ Bugedo CR Carcamo RA Mertens et al. (1990) ArticleTitlePreoperative percutaneous ilioinguinal and iliohypogastric nerve block with 0.5% bupivacaine for post-herniorrhaphy pain management in adult Reg. Anesth. 15 130–133 Occurrence Handle1:STN:280:By6D1M7jtVw%3D Occurrence Handle2265166

    CAS  PubMed  Google Scholar 

  20. JF Butterworth GR Strichartz (1990) ArticleTitleMolecular mechanisms of local anesthesia: a review Anesthesiology 72 711–734 Occurrence Handle1:CAS:528:DyaK3cXhvFWht7g%3D Occurrence Handle2157353

    CAS  PubMed  Google Scholar 

  21. MG Garry DL Jackson HE Geier et al. (1999) ArticleTitleEvaluation of the efficacy of bioerodible bupivacaine polymer system on antinociception and inflammatory mediator release Pain 82 49–55 Occurrence Handle10.1016/S0304-3959(99)00032-9 Occurrence Handle1:CAS:528:DyaK1MXksV2quro%3D Occurrence Handle10422659

    Article  CAS  PubMed  Google Scholar 

  22. J Chen S Dohi Z Tan et al. (2002) ArticleTitleThe inhibitory effect of local anesthetics on bradykinin-induced phospholipase D activation in rat pheochromocytoma PC12 cells Anesth. Analg. 95 88–97 Occurrence Handle10.1097/00000539-200207000-00016 Occurrence Handle1:CAS:528:DC%2BD38Xlsl2is78%3D Occurrence Handle12088949

    Article  CAS  PubMed  Google Scholar 

  23. YM Li DE Wingrove HP Too et al. (1995) ArticleTitleLocal anesthetics inhibit substance P binding and evoked increases in intracellular Ca2+ Anesthesiology 82 166–173 Occurrence Handle10.1097/00000542-199501000-00021 Occurrence Handle1:CAS:528:DyaK2MXltlCntbg%3D Occurrence Handle7530414

    Article  CAS  PubMed  Google Scholar 

  24. CW Roberge M McEwen (1998) ArticleTitleThe effect of local anesthetics on postoperative pain AORN J. 68 1003–1012 Occurrence Handle1:STN:280:DyaK1M%2Fot1Wisg%3D%3D Occurrence Handle9864591

    CAS  PubMed  Google Scholar 

  25. A Pasqualucci (1998) ArticleTitleExperimental and clinical studies about the preemptive analgesia with local anesthetics. Possible reasons of the failure Minerva Anest 64 445–457 Occurrence Handle1:STN:280:DyaK1M%2FnsV2mtg%3D%3D Occurrence Handle9857627

    CAS  PubMed  Google Scholar 

  26. DJ Kelly M Ahmad SJ Brull (2001) ArticleTitlePreemptive analgesia II: recent advances and current trends Can. J. Anaesth. 48 1091–1101 Occurrence Handle1:STN:280:DC%2BD3Mnpslyksg%3D%3D Occurrence Handle11744585

    CAS  PubMed  Google Scholar 

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Acknowledgment

This study was supported by the Siriraj Development Fund.

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Correspondence to Varut Lohsiriwat M.D..

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Lohsiriwat, V., Lert-akyamanee, N. & Rushatamukayanunt, W. Efficacy of Pre-incisional Bupivacaine Infiltration on Postoperative Pain Relief after Appendectomy: Prospective Double-blind Randomized Trial. World J. Surg. 28, 947–950 (2004). https://doi.org/10.1007/s00268-004-7471-8

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  • DOI: https://doi.org/10.1007/s00268-004-7471-8

Keywords

  • Morphine
  • Postoperative Pain
  • Acute Appendicitis
  • Postoperative Pain Relief
  • Morphine Injection