Legeby, M., Jurell, G., Beausang-Linder, M., & Olofsson, C. (2009). Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery/Nordisk Plastikkirurgisk Forening [and] Nordisk Klubb for Handkirurgi, 43(6), 315–319.doi: 10.1080/02844310903259108
To compare, in patients undergoing breast reconstruction, the efficacy of levobupivacaine in conjunction with oral paracetamol and IV morphine to the efficacy of placebo in conjunction with oral paracetamol and IV morphine
Levobupivacaine 2.5 mg/ml or normal saline (NS) was administered through an indwelling catheter every 3 hours for 45 hours with
Prospective placebo-controlled, double-blind study
When patients were at rest, levobupivacaine significantly reduced pain (p < 0.05) 15 hours postoperatively. With movement, levobupivacaine significantly reduced pain for 6 hours (p = 0.01) and significantly reduced pain for 18–24 hours (p = 0.045). Total dose of morphine used did not differ between groups. Two patients in the levobupivacaine group became infected. Authors noted no significant intergroup differences related to nausea or length of hospital stay.
Compared with patients who received placebo, those who were intermittently injected with levobupivacaine had better pain relief at rest for the first 15 hours after surgery. Those who received intermittently injected levobupivacaine also had better pain relief during mobilization, for the first 6 hours and for 18–24 hours.
Boluses of local anesthetic, delivered via patient-controlled anesthesia, tend to have good results because patients prefer to control their own treatment.