• P T Willard and N P Blair.
• Division of General Surgery, Royal Columbian Hospital, University of British Columbia, Vancouver.
• Can J Surg. 1997 Jun 1;40(3):213-7.

ObjectiveTo assess the efficacy of wound infiltration with local anesthetic in reducing postoperative pain after a muscle-splitting incision for appendectomy.DesignA double-blind, placebo-controlled, randomized clinical trial.SettingThe Royal Columbian Hospital, a university-affiliated community hospital.ParticipantsForty-three patients scheduled to undergo emergency appendectomy were randomized into treatment (21) and control (22) groups. Five patients were excluded from the treatment group.InterventionsLocal anesthetic infiltration of the wound before incision (treatment group) and saline infiltration (control group).Main Outcome MeasuresPostoperative analgesic requirements, pain assessment by visual analogue scale and length of hospital stay.ResultsNo significant difference in analgesic use was seen between the 2 groups, as measured at 3 stages (Mc = control mean [standard deviation], Mt = treatment mean [standard deviation]): (a) in the recovery room, intravenous morphine use was Mt = 6.6 mg [8.6] v. Mc = 10.1 mg [7.2]; (b) in the first 2 postoperative days, intramuscular meperidine use was Mt = 309 mg [181] v. Mc = 278 mg [125] on day 1 and was Mt = 121 mg [132] v. Mc = 97 mg [128] on day 2; (c) in the final 5 days of follow-up, oral analgesic use was Mt = 11 [17] tablets v. Mc = 21 [16] tablets (acetaminophen with codeine). Pain assessments at rest, on a scale of 1 to 10, were found to be no different between groups, ratings being Mt = 4.7 [2.1] v. Mc = 4.5 [2.0] on day 1. Length of hospital stay averaged 3.0 days in both groups.ConclusionsInfiltration with local anesthetic before incision does not pre-empt postoperative pain from a muscle-splitting incision used for appendectomy.

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