Randomized clinical trial comparing two different techniques of local anesthesia (subcutaneous versus subcutaneous & deep infiltration) for postoperative pain in patients undergoing open appendecectomy.

This study compared the postoperative analgesic effect of local anesthetic (LA) injected subcutaneous (SC) alone versus local anesthetic injected both SC and deep in patients undergoing open appendecectomy operations. Sixty patients ASA class I-II undergoing open appendecectomy for presumed acute appendicitis will be randomly assigned into three groups. After routine monitoring, anesthesia induction was performed with propofol, fentanyl and, cis-atracurium; later, maintenance was continued with isoflurane. GA received local infiltration of the skin prior to incision with bupivacaine 0.25% (10 ml), GB received received half the bupivacaine infiltrated into the skin and other half deep-to external oblique prior to incision to create a local nerve field blockade & GC received half dose of saline subcutaneous & half deep to external oblique muscle prior to incision. Postoperative pain was assessed using visual analogue score (VAS) at 1, 4, 8, & 24 hours post extubation. Pethidine 1 mg/kg was given if VAS is ≥ 4. All patients in GA (SC) and Control required postoperative analgesics, compared to only 60% of the patients in GB (SC+deep). Time for the first analgesic requirement was prolonged in GB compared to other groups (P < 0.01). VAS scores were significantly lower in patients of GB in the first 8 hr. postoperative compared to GA &GC (P < 0.01).