Анестезия и клинические исследования
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Local Injection of Bupivacaine Hydrochloride to Reduce Postoperative Pain in Obstetrical and Gynaecological Surgical Incision

Sabat AM Barawi and Shelan Ahmed Saleh

Background and objectives: The post-operative pain experienced by patients after abdominal surgery is significant and this has necessitated studying the efficacy of local injection of Bupivacaine to decrease severity of this pain.

Patients and methods: A prospective, randomized, comparative clinical trial was conducted on 800 women admitted to Maternity Hospital, Erbil, Iraq, for either Caesarean section or any gynaecological abdominal surgery. All were classified as American Society of Anesthesiologists (ASA) physical status I-II. The sample was divided in two groups by systematic random sampling (400 each). Group A was designed to receive 25 mg of Bupivacaine hydrochloride as infiltration at the site of the incision after skin closure and Group B was treated with standard of care. The degree of pain was assessed after 6, 12, 24, 48,72 and 96 h from the operation by using defense and veterans pain rating scale (0-10). The amount and type of systemic painkiller medicine used during the operation day and the first three post-operative days were recorded. Patient satisfaction, time of first mobilization, h of confinement to bed per day and complication rates were compared in both groups. Chi-square (χ²) test and Fisher’s exact test Student’s t-test was used in data analyses. p value of ≤ 0.05 was considered statistically significant and p value of ≤ 0.01 was considered highly significant.

Results: The group treated with post-operative wound infiltration with bupivacaine hydrochloride had lower pain score (p>0.001), earlier mobilization (p<0.001), fewer h of confinement to bed (p<0.001), better patient satisfaction (p<0.001), lower consumption of painkiller medicine (p<0.05, but no significant difference in complication rates (p=0.158).

Conclusion: Instillation of Bupivacaine hydrochloride into the surgical incision is a safe, well-tolerated treatment and it is superior to traditional systemic pain medication in both self-reported and clinical outcomes.