The effect of peri-stomal infiltration with bupivacaine/epinephrine on post-operative pain, nausea and ease of surgery in reversal of loop ileostomies.

OBJECTIVE

Evidence to support the routine use of local anaesthetic in the reversal of loop ileostomy is equivocal. This randomized control study looked at the use of peri-operative infiltration of stoma with 0.25% bupivacaine with 1/200,000 epinephrine on the ease of surgery and its effect on post-operative pain and nausea.

METHODS

Sixty patients were randomized to receive peri-stomal infiltration with either 0.25% bupivacaine with 1/200,000 epinephrine or normal saline. The surgeon graded the surgery as straightforward, intermediate or difficult, and the time for the operation was also recorded. Post-operatively, analgesia was provided via PCA for 24 h. Post-operative pain and nausea scores and total morphine usage median (inter-quartile range) were compared using the Mann-Whitney U test with p < 0.05 considered significant.

RESULTS

There was no difference between the local anaesthetic groups and controls with respect to opiate consumption (p = 0.4), post-operative pain (p = 0.72) or nausea (p = 0.78). Shorter total anaesthetic and operative times were noted in study group, but this was not significant (p = 0.55). However, surgery was found to be easier in the local anaesthetic group (p = 0.0046).

CONCLUSIONS

Peri-stomal infiltration with 0.25% bupivacaine with 1/200,000 epinephrine does not impact on post-operative pain and nausea scores or opiate analgesia use. However, its use is recommended as an aid to dissection in surgery.