Continuous infusion of local anaesthetic following laparoscopic hysterectomy—a randomised controlled trial

Objective To estimate whether a continuous infusion of intraperitoneal local anaesthetic for 48 hours following laparoscopic hysterectomy reduced the need for opioids delivered with a patient‐controlled analgesia pump. Design Double‐blind randomised placebo‐controlled trial. Setting District general hospital in the UK. Population Women undergoing a laparoscopic hysterectomy for a benign indication. Methods Women were randomised to receive either 0.5% levobupivicaine or 0.9% normal saline via an ON‐Q elastomeric pump for 48 hours postoperatively. The amount of opioids used via the patient‐controlled analgesia pump was recorded and pain was measured using an 11‐point Box Scale. Main outcome measures The primary outcome was the amount of patient‐administered morphine used over the first 48 postoperative hours. Secondary outcomes were length of hospital stay, oral analgesia use and level of patient‐reported pain. Results Sixty women participated and completed the trial. There was no difference (P = 0.59) in the median amount of patient‐administered morphine used between the levobupivicaine (23 mg) and placebo (18.5 mg) groups; median group difference 3.0 (95% CI −7.0 to 14.0). There was also no difference in the length of hospital stay with 40% of the treatment group remaining in hospital >48 hours compared with 30% of the placebo group (P = 0.08). Pain scores at all postoperative time points remained similar, with a median group difference in pain scores of 1.0 (95% CI −1.0 to 2.0) at the end of the first postoperative day. Conclusions Continuous infusion of 0.5% levobupivicaine into the peritoneal cavity following laparoscopic hysterectomy does not have any opioid‐sparing effects.