[Wound perfusion with bupivacaine for postoperative pain relief after elective abdominal surgery.]

Local wound perfusion with bupivacaine after elective abdominal surgery seems to be a promising method of reducing postoperative pain. Applicability, effectiveness, side effects and risks were tested in a pilot study with 28 patients. During closure of the laparotomy incision two catheters were inserted, one between peritoneum and fascia and the other subcutaneously. After connection to bacteria filters bupivacaine was administered as boluses four times daily for 3 postoperative days, the dosage being adjusted to the patient's weight. Statistically significant pain reduction measured on the VAS was seen from day 1 to day 3 (immediately postoperative 4.92, day12.12, day 20.94, day 3 0.80). Additional analgesic medication was needed in three patients on day 1, after which pain treatment by catheter perfusion alone was sufficient. No severe side effects occurred, but the study was interrupted nonetheless in 3 patients, 2 of whom had a transit syndrome while the third had more severe hypotension than could be explained by the bupivacaine blood level. No infections and no problems with wound healing occurred during the study. This study proved that the method tested leads to significant pain reduction after elective abdominal surgery and has no severe side effects.