Intravenous or Intra-abdominal Local Anesthetics for Postoperative Pain Management.
Intravenous or Intra-abdominal Local Anesthetics for Postoperative Pain Management.
Local anesthetics (LA) are increasingly used for postoperative pain management.
 Speicifically, several studies have found benefit of LA injected intra-abdominally following
 abdominal hysterectomy. However, it remains unclear whether the pain relief seen is due to
 local anesthetic mechanisms within the abdominal cavity or through systemic absorption. The
 aim of this study is to assess whether lidocaine administered intravenously has similar
 analgesic efficacy as the same dose administered intra-abdominally in patients undergoing
 abdominal hysterectomy. All patients would have rescue analgesia using the patient controlled
 analgesia (PCA) pump with morphine in order to achieve adequate pain management during 24 h.
Abdominal hysterectomy with or without salipingo-oophorectomy is associated with
 moderate-severe postoperative pain. Poor pain control in the postoperative period can lead to
 increased postoperative morbidities and poor quality of life. Furthermore, an emerging
 clinical literature suggests that acute pain may rapidly evolve into chronic pain if poorly
 treated. A meta-analysis of the literature found that > 30% patients had chronic pain one
 year after abdominal hysterectomy (5). Therefore, efficient postoperative pain management is
 imperative for the patient and is one of the new pain management standards recommended
 recently.

 Local anesthetics (LA) have been infiltrated subcutaneously, infused intra-abdominally, as
 well as injected into the peritoneal cavity as a single dose at the end of the operation
 following abdominal hysterectomy with variable effects. When injected as a single dose,
 analgesia is limited to approximately 2-4 hours due to the short duration of action of local
 anesthetics. In one recent study, the authors used a catheter inserted intra-abdominally and
 local anesthetic or placebo infusion into the abdominal cavity for 24 h postoperatively and
 found a reduction in postoperative analgesic requirements by 40% during 4-24 h. In another
 study, the investigators found that LA injected intermittently intra-abdominally resulted in
 better pain relief compared to intra-abdominal infusions.
Inclusion Criteria:

 -  ASA 1-2

 -  30 - 75 yrs

 -  Informed consent

 -  50 - 100 kg

 Exclusion Criteria:

 -  Allergy to LA

 -  Chronic pain

 -  Major liver/kidney insufficiency

 -  AV Block 1-2 Participation in another clinical trial