Local Anesthetic Administration Into Uterine Ligaments or Pelvic Cavity to Attenuate Surgical Stress Response During Abdominal Hysterectomy

Abstract

Objective: Surgically induced neural reflex responses and endocrine metabolic catabolic responses should be alleviated by effective pain-relieving techniques and neural block. The aim of this study was to compare the effects of two different local anesthesia techniques on the stress response during abdominal hysterectomy. Material and Methods: In this prospective, randomized study, 60 patients admitted for benign uterine diseases were divided into three groups; general anesthesia alone (Group CO-group control); general anesthesia plus 3 mL bupivacaine (0.5%) which was injected into the round and uterosacral ligaments (Group IN-group infiltration) bilaterally, and general anesthesia plus pelvic cavity irrigation with 40 mL bupivacaine (0.125%) (group IR-group irrigation). The heart rate, mean arterial pressure, plasma glucose and cortisol levels were recorded perioperatively. Recovery time was recorded and Numerical Rating Scale for pain was obtained 15 minutes after extubation. Results: Heart rate was the highest in Group CO compared to the other groups following the uterine removal and at the postoperative 15(th) minute (P<0.05). The plasma cortisol level was the lowest in Group IN following the uterine removal and the highest in Group CO at the postoperative 15th minute (P<0.05). Values of Numerical Rating Scale for pain were similar among the groups (P>0.05). Conclusions: In addition to general anesthesia, local anesthetic administration into the uterine ligaments or the pelvic cavity may be more effective in attenuating the surgical stress response especially in whom this stress response would be deleterious.