Eficacia de la infusión continua de levobupivacaína en la herida quirúrgica tras cesárea

Résumé

Some patients still report pain after cesarean delivery. Local anesthetic wound infusion might act on peripheral and central sensitization mechanisms. We evaluated the benefits of continuous wound infusion of levobupivacaine after cesarean delivery on secondary hyperalgesia and primary hyperalgesia, pain relief, persistent pain, and inflammatory and metabolic stress response. Seventy healthy women scheduled for cesarean delivery participated in this prospective, randomized, triple-blind trial. Women were randomized to receive continuous wound infusion (0.35% levobupivacaine 7 ml/h for 48 h; Group L) or saline (Group S). The following variables were collected: secondary hyperalgesia; primary hyperalgesia; intensity of postoperative pain; time to first bolus of patientcontrolled analgesia; cumulative dose of rescue morphine and acetaminophen; persistent postoperative pain; biochemical parameters; and adverse events. In Group L, the area of secondary hyperalgesia was significantly reduced [43.4(18.5-80) vs. 68.4(39.0-136) cm2 and 45.1(0.9-89.8) vs. 67.3(31.3-175) cm2 at 24 and 48 h, respectively; group:time interaction p-value < 0.001], the pain threshold was significantly higher at 24 hours [633(441-802) vs. 417(300-572) g.mm-2, p=0.001], and morphine consumption was significantly lower at 24 h [4(2-11) vs 11(6-23), p= 0.003] compared with Group S. Plasma insulin levels were significantly lower in Group L. Levobupivacaine wound infusion might be an effective antihyperalgesic adjunct.