758 Pre-Incisional Infiltration of Local Anaesthetic Is Associated with Reduced Intra-Operative Fentanyl Requirements and Lower Pain Scores in Recovery

Abstract

Introduction: Effective pain management is a pivotal component of day‐surgical pathways. Intra‐operative regional infiltration of long‐acting local anaesthetic (LA) has been shown to be efficacious in reducing post‐operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use. Method: Patients undergoing day‐case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol‐based general anaesthetic. Primary outcomes were intra‐operative/post‐operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post‐operatively). The study ran from October 2019 but was suspended during the COVID‐19 pandemic. Non‐parametric statistical tests were used. Results: 25 patients were randomised. Those receiving pre‐incisional LA had lower fentanyl requirements intra‐operatively (mean; 150mcg vs 186mcg, p<0.05) but similar requirements post‐operatively. Mean pain scores were lower in the pre‐incisional LA group at 1 hour (1.2 vs 2.3, p<0.05) and 3 hours post‐operatively (0.7 vs 1.3, p>0.4). Conclusions: Pre‐incisional infiltration of LA led to a significantly reduced requirement for intra‐operative fentanyl, and significantly lower pain scores at 1 hour post‐operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.