In the July 1997 issue of the ARCHIVES, Bourget et al (1997;132:766-769) found no benefit to preemptive local anesthesia in midline laparotomy incisions. We believe their study, which contradicts several other incisional pain trials, has limited implications for the following reasons.
First, there were variations in the location and extent of the laparotomy incisions, and indications for the surgery were not controlled in their 2 groups.
Second, high visual analog scale pain scores on the first postoperative day (4.5-5.5 of 10) and low patient-controlled analgesia (PCA) dosing (approximately 1.5 mg of morphine sulfate per hour) suggest that PCA was ineffective. Perhaps the patients were not adequately informed on how to use PCA or a low dose limit was set. The PCA would then be unlikely to successfully discriminate between the 2 treatment groups.