THE EFFECTS OF INCISIONAL BUPIVACAINE ON POSTOPERATIVE NARCOTIC REQUIREMENTS, OXYGEN-SATURATION AND LENGTH OF STAY IN THE POSTANESTHESIA CARE UNIT

We compared postoperative pain and narcotic requirements, oxygen saturation (Sao2) and length of stay in the post‐anesthesia care unit (PACU) in patients who received 30 ml of either 0.25% bupivacaine (B) or saline placebo (S) infiltrated into the operative incision. Twenty ASA I–III patients undergoing abdominal surgery were studied in a double‐blinded randomized prospective trial. Study and control groups were not different in patient age, procedure, intra‐operative narcotics administered or preoperative Sao2. In the PACU, patients receiving B had significantly lower analog pain scores (6.0 vs 8.3, P=0.02). They had lower respiratory rates (15.6 b/min vs 19.1, P=0.02), required significantly less narcotic (4.5 mg morphine sulphate vs 11.0, P=0.03) and were discharged from the PACU almost an hour sooner than patients receiving S (P = 0.02). Patients receiving B had significantly higher minimum Sao2 than those receiving S (93.3 % vs 89.9, P=0.04). Discharge pain scores, Sao2 and respiratory rates were not significantly different between B and S groups. Finally, mean requirements for narcotics for the first 24 h were reduced by approximately 30% (from 406.9 mg meperidine to 255.5 mg, P=0.006). This study demonstrates that infiltration of a long‐acting local anesthetic lowers initial pain scores and requirement for narcotics in the PACU. The effect can be seen for at least the first 24 h. A lower requirement for postoperative narcotics is accompanished by faster wake‐up, more alert patients, and, most importantly, higher Sao2 and shorter PACU stay. This may have a significant effect on pulmonary morbidity following abdominal operations. © 1990 Acta Anaesthesiologica Scandinavica Fonden