Comparison of Mean Post-Operative Pain Score with or Without Bupivacaine Infiltration at Incisional Site in Patients Undergoing Midline Laparotomy for Clean and Clean Contaminated Wound

Comparison of Mean Post-Operative Pain Score for Clean and Clean Contaminated Wound

Abstract

Background: In abdominal surgery, midline incision is most often used and it is a major contributor to postoperative pain. Objective: The purpose of the study was to evaluate the effect of local anesthesia by comparing mean post-operative pain scores in patients undergoing midline laparotomy for clean and clean contaminated wounds. Study Design: Randomized controlled trial. Settings: Department of Surgery, Allied Hospital, Faisalabad, Punjab, Pakistan. Duration: From April 6^th, 2018 to October 5^th, 2018. Methods: A total of 80 patients undergoing midline laparotomy and classified as ASA physical status I–II were randomly divided into two equal groups. Before wound closure, patients in Group A received local infiltration of 20 ml of 0.25% bupivacaine with epinephrine (maximum dose 1 mg/kg) into the skin and rectus sheath. Group B received a placebo (2 ml of normal saline). Postoperative pain was assessed using the Visual Analogue Scale (VAS) every hour for 24 hours. Analgesics were administered only when necessary and recorded. Data were analyzed using SPSS version 21. Results: Of the 80 patients, the mean age was 45.83 ± 9.13 years. There were 37 (46.2%) males and 43 (53.8%) females. The mean VAS pain score over 24 hours was significantly lower in the bupivacaine group (4.1 ± 1.52) compared to the placebo group (6.88 ± 1.23), with a p-value of 0.0001. Conclusion: Incisional site bupivacaine instillation significantly decreases the painful sensations as well as requirements for analgesia in comparison with the placebo group thus making it a simple, well-tolerated, and safe treatment in relieving pain after midline laparotomy.