Pain management and bupivacaine

Anupam Nath Gupta, Paras Nath


Background: Pain is an unpleasant experience associated with tissue damage. Peripheral tissue injury results in functional disturbances in the nervous system. Modern anaesthesiologists are not only concerned about preoperative and intraoperative care of the patient but also with postoperative welfare of the patient.

Methods: In present study we have compared the efficacy of injection bupivacaine 0.25% infiltration preoperatively versus postoperatively on duration of postoperative analgesia, VAS (visual analogue scale) at the onset of pain, total analgesia requirement in 24 hours. 150 patients belonging to ASA (American society of anesthesiologists) class I and II between the age of 15 and 75 who underwent lower abdominal surgeries belonging to either sex were included in the study. The patients were randomly allocated to three groups. Control group (C) received 20 ml normal saline, preoperative group (A) received 0.25% bupivacaine before incision, postoperative group (B) received 0.25% bupivacaine before closure.

Results: Duration of analgesia, VAS score at the time of first request of analgesia and total doses of analgesia over 24 hours were recorded. The total analgesia requirement was reduced over 24 hours in the group B in which the infiltration was done postoperatively.

Conclusions: The postoperative infiltration with 0.25% bupivacaine produces longer duration and better quality of analgesia as compared to preoperative infiltration.


Pain, Postoperative, Bupivacaine

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Solanki NS, Goswami M, Thaker N. Bupivacaine infiltration versus diclofinac suppository for post tonsillectomy pain relief in paediatric patients. National J Med Res. 2012;2(1):5-7.

Woolf CJ. Preemptive analgesia treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362-79.

Woolf CJ. Recent advances in the pathophysiology of acute pain. Br J Anaesth. 1989;63(2):139-46.

WHO. WHO Model List of Essential Medicines. October 2013. Retrieved 22 April 2013 Lexicomp. Bupivacaine (Lexi- Drugs). Retrieved 20 April 2014

Alsif A, Ahmad N, Nawaz S, Alotaibi W. Effect of pre-emptive bupivacaine infilteration on post thyroidectomy pain. Internet J Anesthesiol. 2004;9(1).

Egan TD, Warner DO. Miller's Anesthesia. 6th ed. Philadelphia: Elsevier; 2005.

Mehta TR, Parikh BK, Bhosale GP, Butala BP, Shah VR. Postoperative analgesia after incisional infiltration of bupivacaine versus buprinorphine. J Anaesthesiol Clin Pharmacol. 2011;27(2):211-4.

Woolf CJ. Evidence for a central component of post injury pain hypersensitivity. Nature. 1983;306(5944):686-8.

Gatt CJ, Parker RD, Tetzlaff JE, Szabo_MZ, Dickerson A. Am J Sports Med. 1999;27:544-5.

Ke RW, Portera SG, Bagous_W, Lincoln SR. ObstetGynecol. 1998;92:972-5.

Ko CY, Thompson JE, Alcantra A, Himaya D. Preemptive analgesia in patients undergoing appendectomy. Arch Surg. 1997;132(8):874-7.

Hannibal K, Galatius H, Hansen A, Obel E, Ejlersen E. Preemptive wound infiltration with bupivacaine reduces early and late opioid requirement after hysterectomy. Anesth Analg. 1996;83(2):376-81.

Poberson LH, Snyed JR. Wound infiltration after surgery to the cervical spine using a posterior approach. Br J Anaesth. 2000;84(1):87-8.

Aida S, Baba H, Yamakura T, Taga K, Fukuda S, Shimoji K. The effectiveness of preemptive analgesia varies according to the type of surgery: a randomized double blind study. Anesth Analg. 1999;89(3):711-6.

Wassef MR. Concept of preemptive analgesia for postoperative pain. Mt Sinai J Med. 1998;65(4):271-9.

Goodwin SA. A review of preemptive analgesia. J Perianesth Nurs. 1998;13(2):109-14.

Tripathi KD. Local anaesthetics. Essentials of Medical Pharmacology. 8th ed. New Delhi: Jaypee Brothers Medical Publishers; 2013: 360-71.