Effect of Bupivacaine Adiministration with Catheter in Surgical Wound on Pain after Laparotomy (2008-2009)

Introduction & Pain control after surgery is one of the important issues in postoperative care. Pain alleviation leads to patient satisfaction, faster recovery, and improvement in the function of cardiovascular, respiratory, and gastrointestinal systems. Pain control with anesthetic substances administration in the wound through catheter, is one of the methods which is under study. In this study we assessed Bupivacaine administration in the wound through catheter between and over rectus fascia after midline laparotomy. In this study, after informed consent, the patients were divided into three groups. In one group, a catheter was placed between fascias of each rectus muscle. In other groups two catheters ware placed over fascia, after fascia repair. In first two groups, 5cc Bupivacaine 0.25% was administered through each catheter. In third group, normal saline was used and when patients suffered server pain, 50mg pethidine was administered. Pain score was assessed by visual analogue score and narcotic use and post-operative recovery were compared in the three groups. For statistical analysis, the proportions were compared using chi square test. The continuous variables were compared with ANOVA test followed by Dunnett post-test for significance. All 90 patients under study were similar according to age, gender, incision length, literacy level, and cooperativeness. Pain scores in three groups were different (P < 0.0001) and pain was less in patients with catheter in their wounds. Dose of pethedine administration in patients with catheters between rectus fascias, over fascias, and the control group were 250±97.3, 293.2±135.7, and 357±116.6 milligrams respectively (P=0.01). Time of return of bowel sound and gas passage, and hospital stay after surgery were longer in the central group than the other two groups significantly. No wound complication was seen in patients with catheter. There was no significant difference between the two groups with catheters. Bupivacaine administration with catheter in surgical wound after midline laparotomy can reduce pain. This method can reduce period of ileus and hospital stay without major complications. Inserting Bupivacaine catheter between rectus muscle fascias was not significantly beneficial and needs more studies.