objective: (LA) wound irrigation (WI) for postoperative (PO) analgesia.
Patients & Methods: The study included 40 female patients with mean age of 34.1±3.4 years. All
surgeries were performed through Kocher's subcostal incision, during muscle cutting, the neurovascular
was identified and after peritoneal drainage and closure, an 8F neonatal feeding catheter with fashioned
multiple pores was inserted partly between anterior abdominal wall muscles and partly under
subcutaneous tissue directly on the neurovascular bundle. Patients were divided into: Control group
(Group C) received WI using 0.9% saline and Study group (Group S) received 8-hourly WI using 20
nil of bupivacaine 0.25% for 48 hours. Wound pain was assessed iSing 10-mm visual analogue scale
(VAS). Duration of PO analgesia and frequency of requests and total dose of intravenous mepridine,
time for first ambulation and oral intake were recorded. All patients were discharged after irrigation
catheter removal on the morning of the 31'd PO day.
Results: All surgeries were completed uneventfully without complications within a mean operative
time of 46.5:0.3 minutes. Patients received LA irrigation showed significantly longer duration of
analgesia with significantly lower frequency of requests and total dose of mepridine and • lower
cumulative VAS pain score compared to control group. Mean time till
ambulation and oral intake
was significantly shorter in Group S compared to group C. Seven patients had postoperative nausea
and/or vomiting (PONV), 4 in control and 3 in study group and only one patient in control group
required stoppage of oral intake, but all patients responded well to antiemetic therapy.
Conclusion: Wound irrigation with bupivacaine significantly improved outcome of open
cholecystectomy and could be advocated for various open surgical procedures. The applied modality
was safe, elTective and cost reducing with significant opioid sparing effect. |
