Intermittent epidural vs continuous wound infusion of ropivacaine for acute and chronic pain control after hysterectomy or myomectomy: A randomized controlled trial

Abstract

Adequate postoperative analgesia may enhance recovery. The efficacy of continuous wound infusion vs intermittent epidural ropivacaine for postoperative analgesia was investigated. Design: Prospective randomized, observer blind trial. Setting: Aretaieio University Hospital. Subjects: Patients scheduled for open abdominal hysterectomy or myomectomy. Methods: Patients received 10mL of 0.75% ropivacaine along the skin incision before skin closure, followed by wound infusion 2mL/hour of 0.375% ropivacaine or epidurally 10mL of 0.75% ropivacaine in the beginning of surgery followed by 10mL of 0.2% ropivacaine 6 hourly. The epidural injections or the wound infusion of ropivacaine lasted 48 hours. Rescue analgesia consisted of patient-controlled analgesia morphine up to 48 hours and acetaminophen/codeine tablets the next 24 hours. Analgesic consumption and visual analog scale pain at rest and during cough were assessed 2, 4, 8, 24, 48, and 72 hours postoperatively. One and three months later, patients were interviewed by phone for analgesic consumption at home and presence of pain. Results: The subcutaneous group consumed more morphine during the first 2, 4, and 8 hours postoperatively (P<0.001, P<0.001, and P<0.001, respectively). Subsequent morphine and acetaminophen/codeine requirements did not differ between the two groups. Pain intensity during cough was higher only 2 hours after surgery in the subcutaneous group (P=0.002). Three months postoperatively, the two groups did not differ in the analgesic requirements and presence of persisting and/or burning pain. Conclusion: Based on our results, there is no clinical significant difference between the epidural ropivacaine and the subcutaneous ropivacaine group or a clear superiority to one management strategy.