Regional delivery of local anesthetic agents for postoperative analgesia following femoropopliteal arterial reconstruction

ABSTRACT

This study describes a new concept for postoperative analgesia following femoropopliteal arterial reconstruction by placing an indwelling catheter along the surgical wound, through which pulses of a local anesthetic agent can be delivered in the postoperative period. Twenty-five patients undergoing femoropopliteal bypass grafting with saphenous vein for superficial femoral arterial occlusive disease were included [16 males, 9 females. Mean age 59 +/- 6 years]. Patients were randomized into two groups for postoperative pain relief Group I [n=12] were assigned to regional delivery of Bupivicaine 0.25% 5cc every 8 hours via an indwelling catheter placed along the wound for 48 hours. Group II [n-13] received Pethidine 1mg/Kg IM every 8 hours for 48 hours. Patients experiencing breakthrough pain during the 8-hour period between doses received IM injection of Diclofenac potassium 75mg. Postoperative pain was rated by means of a visual analog scale. The pain score during the first 48 hours following surgery was 3.25 +/- 0.87 for Group I compared to 5.08 +/- 1.04 for Group II, p<0.0001. Only two patients in Group I required Diclofenac doses for breakthrough pain compared to 8 patients in Group II, p < 0.05. The mean dose of Diclofenac per patient was 31.25 +/- 74.7mg for Group I vs 103.85 +/- 89.5mg for Group II, p < 0.05. There was no significant difference between the two groups regarding wound problems or hospital stay. Regional delivery of a local anesthetic [Bupivicaine] via an indwelling catheter following femoropopliteal bypass surgery is a simple, safe and effective method for providing prolonged postoperative analgesia. This technique should be considered for wider use among these patients