Investigation of the Effect of Local Anesthesia Application on the İncision Line on Patient Comfort in Patients Who Underwent Pfannestiel İncision-Prospective Case-Control Study
Main Article Content
Abstract
AİM: It was aimed to investigate the effect of local anesthetic application on the Pfannenstiel incision line on patient comfort.
METHODS: The study was carried out between 2021 and 2022. It was performed on 240 patients. The patients were categorized as Group 1 in which a local anesthetic was administered and Group 2, which was not administered a local anesthetic. It was performed on 120 hysterectomy cases operated under general anesthesia. 5 mg 0.5% bupivacaine was used as a local anesthetic. The patients were evaluated in terms of postoperative pain score, gas-gaita release time, postoperative mobilization, narcotic analgesic requirement, post-operative home comfort, daily return to basic work, and feeling like they used to be. For statistical analysis, SPSS Version 28.0.1 program was used.
RESULTS: A statistically significant decrease was observed in postoperative 2nd-hour pain scores in Group 1 patients compared to Group 2 (p=0.007). A statistically significant decrease was found in the need for narcotic analgesics in Group 1 patients (p=0.04). Gas-stool release time was shorter in Group 1 patients compared to Group 2, and it was statistically significant (p=0.038). Mobilization was easier in the 1st group of patients and it was found to be statistically significant compared to the 2nd group (p=0.004). In other parameters, there was no difference between the two groups.
CONCLUSİON: Applying local anesthesia to the incision site reduces pain in the first 2 hours postoperatively, earlier gas-gaita output, comfortable mobilization, and a decrease in the need for narcotic analgesics.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167(2):84-96. doi:10.1080/110241501750070510
II. Ertekin C. Ağrının nöroanatomi ve nörofizyolojisi. Ağrı ve Tedavisi. Yegül Y (ed). İzmir: Yapım Matbaacılık, 1993; 1-18.
III. Hopf HW, Weitz S. Postoperative pain management. Arch Surg. 1994;129(2):128-132. doi:10.1001/archsurg.1994.01420260014002
IV. Pogatzki-Zahn EM, Segelcke D, Schug SA. Postoperative pain-from mechanisms to treatment. Pain Rep. 2017;2(2):e588. Published 2017 Mar 15. doi:10.1097/PR9.0000000000000588
V. Sartain JB, Barry JJ. The impact of an acute pain service on postoperative pain management. Anaesth Intensive Care. 1999;27(4):375-380. doi:10.1177/0310057X9902700408
VI. American Academy of Family Physicians. Family Medicine Facts. 2018. www.aafp.org/about/the-aafp/family-medicine-specialty/facts/table-12(rev).html. Accessed April 27, 2020.
VII. Colvin L.A. Physiology and pharmacology of pain. in: Thompson J.P. Wiles M.D. Moppett I.G. Smith and Aitkenhead's textbook of anesthesia. 7th and. Elsevier, St Louis2019: 100-121
VIII. Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90(4):899-912. doi:10.1097/00000539-200004000-00024
IX. U Berggren, T Gordh, D Grama, U Haglund, J Rastad, D Arvidsson, Laparoscopic versus open cholecystectomy: Hospitalization, sick leave, analgesia and, trauma responses, British Journal of Surgery, Volume 81, Issue 9, September 1994, Pages 1362–1365, https://doi.org/10.1002/bjs.1800810936
X. Mraović B, Jurisić T, Kogler-Majeric V, Sustic A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 1997;41(2):193-196. doi:10.1111/j.1399-6576.1997.tb04664.x
XI. Pasqualucci A, de Angelis V, Contardo R, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology. 1996;85(1):11-20. doi:10.1097/00000542-199607000-00003
XII. Chundrigar, T., Hedges, A.R., Morris, R., & Stamatakis, J.D. (1993). Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Annals of the Royal College of Surgeons of England, 75 6, 437-9. Corpus ID: 41028457
XIII. Helvacioglu A, Weis R. Operative laparoscopy and postoperative pain relief. Fertil Steril. 1992;57(3):548-552.
XIV. Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaanestheticr shoulder pain after day-case laparoscopy. Lancet. 1991;338(8782-8783):1569-1570.
doi:10.1016/0140-6736(91)92384-e
XV. Callesen T, Hjort D, Mogensen T, et al. Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth. 1999;82(4):586-590.
doi:10.1093/bja/82.4.586
XVI. Ghezzi F, Cromi A, Bergamini V, et al. Preemptive port site local anesthesia in gynecologic laparoscopy: a randomized, controlled trial. J Minim Invasive Gynecol. 2005;12(3):210-215. doi:10.1016/j.jmig.2005.03.007
XVII. Grube JO, Milad MP, Damme-Sorenen J. Preemptive analgesia does not reduce pain or improve postoperative functioning. JSLS. 2004;8(1):15-18.
XVIII. Arden D, Seifert E, Donnellan N, Guido R, Lee T, Mansuria S. Intraperitoneal instillation of bupivacaine for reduction of postoperative pain after laparoscopic hysterectomy: a double-blind randomized controlled trial. J Minim Invasive Gynecol. 2013;20(5):620-626.
doi:10.1016/j.jmig.2013.03.012
XIX. Ravndal C, Vandrevala T. Preemptive Local Anesthetic in Gynecologic Laparoscopy and Postoperative Movement-Evoked Pain: A Randomized Trial. J Minim Invasive Gynecol. 2016;23(5):775-780. doi:10.1016/j.jmig.2016.03.009
XX. Chou YJ, Ou YC, Lan KC, Jawan B, Chang SY, Kung FT. Preemptive analgesia installation during gynecologic laparoscopy: a randomized trial. J Minim Invasive Gynecol. 2005;12(4):330-335. doi:10.1016/j.jmig.2005.05.005
XXI. Ong CK, Lirk P, Seymour RA, Jenkins BJ. The efficacy of preemptive analgesia for acute postoperative pain management: a meta-analysis. Anesth Analg. 2005;100(3):757-773.
doi:10.1213/01.ANE.0000144428.98767.0E
XXII. Marks JL, Ata B, Tulandi T. Systematic review and metmeta-analysis intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. J Minim Invasive Gynecol. 2012;19(5):545-553. doi:10.1016/j.jmig.2012.04.002
XXIII. Long JB, Bevil K, Giles DL. Preemptive Analgesia in Minimally Invasive Gynecologic Surgery. J Minim Invasive Gynecol. 2019;26(2):198-218. doi:10.1016/j.jmig.2018.07.018
XXIV. Kato J, Ogawa S, Katz J, et al. Effects of presurgical local infiltration of bupivacaine in the surgical field on postsurgical wound pain in laparoscopic gynecologic examinations: a possible preemptive analgesic effect. Clin J Pain. 2000;16(1):12-17. doi:10.1097/00002508-200003000-00003
XXV. Altay N. , Dölalan S. , Uzunköy A. INTRAPERITONEAL AND INCISIONEL LOCAL ANESTHETIC ADMINISTRATION FOR POSTOPERATIVE PAIN MANAGEMENT IN LAPAROSCOPIC SURGERY. Journal of Surgical Arts. 2009; 2(2): 1-6.
XXVI. Altuntaş G, Akkaya ÖT, Özkan D, Sayın MM, Balas Ş, Özlü E. Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy. Turk J Anaesthesiol Reanim. 2016;44(6):306-311. doi:10.5152/TJAR.2016.75983
XXVII. Møiniche S, Jørgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg. 2000;90(4):899-912. doi:10.1097/00000539-200004000-00024