Analgesia following appendicectomy — the value of peritoneal bupi-vacaine

Purpose: Peritoneal inflammation is an important feature in many patients presenting with appendicitis, The contribution of peritoneal nerve fibres to pain experienced after appendicectomy has received little attention. Method: In this prospective double blind randomized study a consecutive series of 60 patients undergoing appendicectomy for suspected appendicitis were enrolled. A dose of 1.5 mg.kg(-1) bupivacaine 0.5 % was used. Group one patients received the entire dose of bupivacaine subcutaneously, Group two patients received half the dose subcutaneously (sc) and half the dose to the peritoneum. Pain scores were assessed pre-operatively and at 30 min, 12 and 24 hr post-operatively using a visual analogue scale, Time to first analgesia and total analgesia requirements in the first 24 hr were recorded. Results: The patients receiving the sc combined with peritoneal bupivacaine had a lower pain score 30 min postoperatively (32 +/- 2 vs 54 +/- 4; P < 0.0001), a longer time to first analgesia (248 +/- 20 vs 164 +/- 17 min; P = 0.002) as well as lower opioid (68 +/- 5 vs 100 +/- 7 mg; P = 0.0002) and non steroidal analgesic requirements (65 +/- 6 vs 96 +/- 6 mg; P = 0.007) in the first 24 hr post-operatively Conclusion: A combination of sc and peritoneal infiltration with bupivacaine is superior to skin infiltration alone in the relief of pain post appendicectomy

Timing of pre-emptive tenoxican is important for postoperative analgesia

Purpose: In this prospective randomized study a comparison was made between the efficacy of 20 mg tenoxicam, administered either, 30 min preoperatively or at induction of anesthesia, for the relief of postoperative pain in patients undergoing ambulatory breast biopsy. Methods. Seventy-three patients were recruited and all received a standard anesthetic consisting of induction with 2 mg.kg(-1) propofol followed by 5 mug.kg(-1) alfentanyl. No premedication was administered and at the end of the procedure the wounds were infiltrated with 10 ml of bupivacaine (0.5 %). Patients were randomized to receive 20 mg tenoxicam intraveneously either 30 min before surgery or at induction of anesthesia. Results: Demographic criteria were similar in both groups. There were differences in pain scores at 30, 60, 120 and 240 min postoperatively (VAS at 30 min 3.2 +/- 1.2 vs 5.5 +/- 1.8; P < 0.001: VAS at 60 min 1.8 +/- 1.2 vs 3.7 +/- 1.9, P < 0.001: VAS at 120 min 0.9 +/- 0.9 vs 1.7 +/- 1.0: P = 0.003: VAS at 240 min 0.5 +/- 0.5 vs 1.1 +/- 0.8; P < 0.001: Expressed as mean +/- SD). There was a difference in the number of patients requiring additional analgesia, in the first four hours postoperatively (12 (33%) vs 27 (73%); P = 0.001) and a difference in the time to additional analgesia in these patients (87.5 +/- 32.5 vs 55.0 +/- 26.8 min: P = 0.002). Conclusion: Early administration of pre-emptive tenoxicam 30 min before induction of anesthesia improves postoperative analgesia in patients undergoing ambulatory breast biopsy