Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management

Objective: To evaluate the impact of preemptive local analgesia at the incision site in reducing pain in women undergoing abdominal hysterectomy for a benign myomatous uterus. Study design: In this prospective, randomized, double-blinded, placebo-controlled study, 20 mL of 1% lidocaine or 0.9% saline was injected at the abdominal incision site prior to the performance of the hysterectomy. Thirty-two women were enrolled in the study, 16 received preemptive analgesia while 14 were treated by placebo; 2 were excluded. All operations were performed under general anesthesia. The standard postoperative pain treatment consisted of oral analgesia with ibuprofen (400 mg) in liquid-filled capsules. Morphine (10 mg) was used for rescue analgesia. Pain intensity was self-evaluated with the use of a 100 mm visual analog scale. Results: Compared to the placebo group, women who received preemptive analgesia with lidocaine 1% perceived a significant reduction in postoperative pain in the first hours after surgery (2 h: 50.1 ± 27.9 versus 70.6 ± 22.6, p = 0.043; 5 h: 42.5 ± 25.2 versus 64.6 ± 28.3, p = 0.043; 8 h: 31.2 ± 22.4 versus 53.3 ± 30.3, p = 0.031). Conclusion: Preemptive analgesia with lidocaine 1% is a simple, cheap and efficient mode to reduce pain in the first hours after hysterectomy.