Date of Award

2020

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dr. Stanley Mugambi

Second Supervisor/Advisor

Dr. Abdallah Abdulkarim

Third Supervisor/Advisor

Dr. David Odaba

Department

General Surgery (East Africa)

Abstract

Background: Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients

Objective: To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients.

Design: A randomised, single-blind, controlled clinical trial.

Setting: Aga Khan University Hospital, Nairobi, Kenya.

Population: Patients undergoing elective laparotomy.

Methods: Thirty eight patients scheduled for elective laparotomy were randomized into two equal groups to receive either continuous local anaesthetic wound infusion or thoracic epidural analgesia. Data of the baseline characteristics, total morphine consumption at 72 hours, visual analogue scores and rates of adverse effects were collected.

Results: Baseline characteristics of the participants were similar. Continuous local anaesthetic wound infusion was equivalent to thoracic epidural analgesia in terms of total morphine consumption at 72 hours. Duration of hospital stay was shorter in the intervention arm however visual pain scores were equal between the two groups. Comparatively we observed more surgical site infections in the intervention arm with more dislodged catheters in the thoracic epidural arm.

Conclusion: Continuous local anaesthetic wound infusion provides an alternative modality in management of post-operative pain in patients who have undergone elective laparotomy.

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Surgery Commons

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