• Bo S Kristensen, Christian Fenger-Eriksen, Knud V Pedersen, and Sven Felsby.
• Department of Anaesthesiology and Intensive Care, Aarhus University Hospital Skejby, Skejby, Aarhus, Denmark. bsk@dadlnet.dk
• Eur J Anaesthesiol. 2013 Mar 1;30(3):124-8.

ContextThe effectiveness of postoperative analgesia through a wound catheter is subject to considerable debate.ObjectiveTo test the hypothesis that local wound infusion with bupivacaine followed by continuous infusion could reduce postoperative need for opioids in patients undergoing retropubic prostatectomy.DesignSingle-centre prospective, double-blinded, placebo-controlled trial.SettingA major university hospital in Denmark.PatientsFollowing written informed consent, 60 patients scheduled for prostatectomy were recruited to the study and 50 completed the protocol to reach data analysis.InterventionsThirty millilitre bolus of bupivacaine (2.5 mg ml) or isotonic saline was injected through a subfascially placed wound catheter followed by continuous infusion at 5 ml h during the following 48 h. All patients were prescribed paracetamol, non-steroidal anti-inflammatory drugs, morphine and oxycodone if needed.Outcome MeasuresPrimary outcome was the opioid requirement. Secondary outcomes included pain scores at rest and with activity, and nausea and vomiting scores.ResultsThe total amount of morphine required during the postoperative period was not significantly higher (P=0.49) in the placebo group (12 mg, 25 to 75% percentile 5 to 18) than the bupivacaine group (10 mg, 25 to 75% percentile 0 to 16). Similarly, the total amount of oxycodone required was not significantly different (P=0.99) and was equal among the groups (5 mg, 25 to 75% percentile 5 to 10). At 2 h postoperatively, a significantly (P=0.0488) higher number of patients required additional morphine in the placebo group. No differences between the groups were detected at any time point regarding pain scores or the presence of nausea and vomiting.ConclusionAdditional use of a wound catheter in patients undergoing prostatectomy in the present perioperative setting appears superfluous.

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