The preemptive effect of pre-incisional bupivacaine infiltration on postoperative analgesia following lower abdominal surgery under epidural anesthesia.

BACKGROUND: In attempts to reduce central sensitization after tissue injury, the concept of preemptive analgesia has evolved. The aim of the present study was to evaluate the preemptive effect of pre-incisional infiltration of the surgical area with bupivacaine on pain following lower abdominal surgery under epidural anesthesia. METHODS: Sixty female patients scheduled for lower abdominal surgery under epidural anesthesia with bupivacaine were randomly divided into two Groups (n = 30, each). Five minutes before surgical incision, patients in Group 1 received subcutaneous infiltration of the proposed surgical area with 30 ml of 0.125% bupivacaine (with 1/200,000 epinephrine), while those in Group 2 received 30 ml of isotonic saline (with 1/200,000 epinephrine) infiltration. Postoperatively, pain was assessed for 48 h by a visual analogue scale of pain at rest, during cough and by cumulative morphine doses (self-administered by patient-controlled analgesia). RESULTS: The pain score at rest was significantly lower in Group 1 than in Group 2 from the 6th h to the 24th h postoperatively. The cough-associated pain score was lower in Group 1 than in Group 2 from the 6th h to the 28th h postoperatively. Furthermore, Group 1 consumed less morphine than did Group 2 from the 6th h to the 24th h postoperatively. CONCLUSIONS: The results indicate that pre-incisional infiltration of surgical area with bupivacaine markedly decreases the intensity of pain following lower abdominal surgery under epidural anesthesia.