Efficacy of Wound Infiltration with 20ml of 0.25% Bupivacaine in Patients Undergoing Hysterectomies in General Anaesthesia

Abstract

Objectives: To determine the efficacy of local wound infiltration with 20 ml of 0.25% bupivacaine vs. control in post-operative management of pain in Hysterectomies.
Methodology: A randomized controlled trial study was conducted at the Department of Obstetrics and Gynecology, MCH Center, PIMS, Islamabad from 06-11-2017 to 05-04-2018A total of 90 female patients between age 40-60 years undergoing abdominal hysterectomies were enrolled. Forty five women (n=45) were allocated into two groups. Group A (study group) was comprised of those who received infiltration of 20 ml of 0.25% bupivacaine around the wound and surrounding tissues, while Group B patients were infiltrated with 0.9% normal saline and served as a control group. Analgesic consumption was assessed 3, 6, 12 and 24 hours postoperatively. Intravenous diclofenac 75 mg and injection toradol 30 mg was used as rescue analgesia in patients complaining of moderate to severe pain despite receiving initial intervention. Final results were recorded in the form of rescue analgesia requirements every 24 hours and mean VAS at 24 hours in both groups and were compared in both groups for statistical significance.
Results: The mean age in was 47.3 years ± 4.5 SD and 49.8 years ± 5.9 SD in study and control group respectively. In the study and control groups, the mean BMI was 33.7 kg/m2 4.6 SD and 29.2 kg/m2 2.1 SD, respectively. study group, the mean VAS was 2.8 ± 0.77 SD at 24 hours while in control group it was 3.5 ± 0.97 SD (P=0.001).. In study group, mean dose of dicolfenac in 24 hours was 56.7 mg ± 36.3 SD hours while in control group it was 105.1 mg ± 49.1 SD (P=0.001). In study group, mean dose of toradol in 24 hours was 36.7 mg ± 15.5 SD hours while in control group it was 58.1 mg ± 21.6 SD (P= 0.001), implying injection diclofenic and toradol consumption were significantly lower in Bupivicaine group as compared to control group. A similar trend was observed when data was stratified with respect to age and BMI (P<0.05 in all cases).