Zahid Aman, Abdul Qayum, Kifayat Khan.
A study of effectiveness of local Bupivacaine infiltration of the wound in reducing the post operative parenteral narcotic analgesic requirement.
J Postgrad Med Inst Jan ;18(1):7-11.

Objective: To see the effectiveness of local perfusion of the wound with bupivacaine .5% following cholecystectomy was studied. Material and Methods: A prospective randomized clinical trail involving 140 patients undergoing cholecystectomy for symptomatic gallstones, using Kocher`s incision, was undertaken. Patients were randomized to receive either intermittent intravenous tramadol infusion on demand (parenteral analgesia, PA-group) or wound perfusion with local bupivacaine .5% per-operatively followed by intravenous tramadol infusion, if needed (local analgesia, LA-group). On hundred and forty patients were recruited in the study, 70 in each group. Patient demographics were comparable in the two groups. Results: There was no statistically significant difference in post-operative pain scores at rest and with movement between the two groups, excepts for pain scores at rest on the first post-operative day (P = 0.03). The median total amount of tramadol used was significantly greater in PA group i.e. 600 (range 500-1000) mg as compared to the amount used in LA-group i.e. 200 (range 0-400) mg. Conclusion: Direct local wound perfusion of bupivacaine 0.5% provides good pain relief after cholecystectomy and reduces the requirements of parenteral narcotic analgesia with no major side effect. In other words it is a safe and feasible alternative to parenteral opiods.

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