Effectivity of local bupivacaine infusionin the prevention of postoperative ileus

Abstract

AimInflammation is the predominant factor in the development of gastrointestinal dysmotility or postoperative ileus although dissection and neurological and inflammatory factors secondary to intestinal manipulation have been blamed. In this study, we investigated the effectivity of local bupivacaine infusion for prevention of postoperative ileus.MethodThis retrospective study included patients that underwent median laparotomy and received conventional analgesia alone or conventional analgesia followed by local bupivacaine. Patients that received conventional analgesia (nonsteroidal anti-inflammatory drugs [NSAIDs] + opioids) followed by local bupivacaine infusion (15 mg/h during 48h) with Pain buster pump system were classified as Group 1 (n=30) and the patients that received conventional analgesia alone ([NSAIDs] + opioids) were classified as Group 2 (n=31).ResultsThe groups were similar in terms of age, gender, preoperative ASA score, surgical technique, and operative time. The Visual Analog Scale (VAS) scores during the periods 8-24 and 24-48 h and the analgesic requirement during the periods 0-8, 8-24, and 24-48 h were significantly decreased in Group 1 compared to Group 2 (p<0.05). In Group 1, active postoperative bowel sounds started earlier (38 vs. 47 h) and mean time to first flatus/defecation was significantly lower than in Group 2 (64.13 ± 9.06 vs. 77.90 ± 10.25 h) (p<0.05).ConclusionTransfascial bupivacaine infusion appears to be an effective technique since it reduced early postoperative pain and postoperative analgesic requirement and also provided favorable effects in the prevention of postoperative ileus, thereby leading to shorter intensive care unit stay.

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