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Preoperative infiltration of bupivacaine ‐ effects on pain relief and trauma response (cortisol and interleukin‐6)

1997; Wiley; Volume: 41; Issue: 4 Linguagem: Inglês

10.1111/j.1399-6576.1997.tb04725.x

1399-6576

Marianne Eriksson-Mjöberg, Marianne Kristiansson, Kjell Carlström, Johanna Eklund, Lars L. Gustafsson, Anders Ölund,

Adrenal Hormones and Disorders

Subcutaneous infiltration of bupivacaine before skin incision can reduce postoperative pain and modulate the stress response.In a randomized study on pain relief after hysterectomy 29 patients were referred into one of three groups, receiving 30 ml of bupivacaine 0.25% with adrenaline, 30 ml of saline or no infiltration along the line of the proposed incision 10 min before start of surgery. A Visual Analogue Scale was used for repeated pain ratings. Postoperative pain relief was provided with patient-controlled analgesia with intravenous morphine 0.04 mg/kg. Lockout time was 10 min. The immunological and endocrine stress response to trauma was reflected by blood interleukin-6 (IL-6) and cortisol concentrations measured during 72 h following skin incision.There were large individual variations in the accumulated postoperative consumption of morphine at 20 h after start of surgery. It was significantly reduced in patients receiving infiltration of bupivacaine. They used 39 mg (9-62) median (range) of intravenous morphine whereas the patients in the saline group used 65 mg (47-120) and patients in the control group used 54 mg (36-130) (P < 0.05). Significant elevation of plasma IL-6 and serum cortisol levels appeared in all groups with peak values at 3 h. There were no differences between the groups. There was a correlation between cortisol and IL-6. Six of the 29 patients had a postoperative infection which was reflected in increased IL-6 levels.Preoperative subcutaneous infiltration of bupivacaine significantly reduced the postoperative consumption of intravenous morphine.