Design: A randomized, double blind, placebocontrolled study.
Setting: Benha University Hospital.
Objective: To evaluate the analgesic effect of post incisional infiltration and intraperitoneal instillation of long acting local anathetic on post-operative pain in non descent vaginal hysterectomy (NDVH).
Patients and Methods: Forty eight women undergoing NDVH received 50 ml ropivacine (0.50%) (n = 24) or 50 ml saline (n = 24) by post incisional infiltration (30 ml) and intraperitoneal instillation (20 ml). Main outcome measures: pain "using visual analogue scale (VAS) score", nausea, vomiting and analgesic requirements were recorded for 24 postoperatively as well as time spent in postanesthesia care unit and time to get out of bed.
Results: The mean pain VAS score after one, two, four, eight, twelve hours postoperatively were significantly lower in ropivacine group (P<0.0001, P≤ 0.0001 , P≤ 0.01, P≤ 0.01, P≤ 0.01). Pain with cough also, was significantly lower in ropivacine group at one, two, four, eight, twelve hours postoperatively (P ≤ 0.0001, P≤ 0.003, P≤ 0.001, P≤ 0.01, P≤0.03) and pain with movement at four, eight hours postoperatively were significantly reduced in ropivacine group (p ≤ 0.004, P≤ 0.008). Nausea, vomiting and time to first get out of bed were significantly lower in ropivacine group (P≤ 0.009, P≤ 0.01, P≤ 0.0001) respectively. Total narcotic dose at one, twenty four hours and total parentral NSAID dose were significantly lower in ropivacine group (P≤0.0003, P≤0.0001, P≤0.001) respectively.
Conclusion: Post incisional local infiltration and intraperitoneal instillation of ropivacine reduces postoperative pain in women undergoing NDVH and promotes early mobilization and enhance early recovery.