Randomized, controlled trial of bupivacaine injection to decrease pain after laparoscopic cholecystectomy.
ABSTRACT To determine if intraoperative instillation of bupivacaine would decrease early postoperative pain after laparoscopic cholecystectomy, if the patients would consequently require less narcotic postoperatively and if such patients would elect to be discharged on the day of operation if given the choice.
Double-blind, randomized, controlled trial.
A tertiary care hospital in Hamilton, Ont.
Fifty patients underwent laparoscopic cholecystectomy. Day-surgery patients had the choice of staying overnight for discharge the following day. They were compared with a control group of 47 patients who had laparoscopic cholecystectomy but did not receive bupivacaine.
Instillation of 20 mL of 0.5% bupivacaine with epinephrine into laparoscopic cholecystectomy port sites intraoperatively before closure.
Visual analogue scale (VAS) pain scores assessed 4 times postoperatively, the choice of patients to leave hospital the same day or to remain in the hospital overnight; the level of postoperative narcotic usage.
Mean VAS pain scores (range 0 [no pain] to 5 [severe pain]) at less than 2 hours and at 6 hours after surgery were 2.9 and 2.9, respectively, in the bupivacaine group compared with 4.5 and 4.0, respectively, in the control group (p = 0.001 and 0.025). VAS scores at 10 hours postoperatively and the next morning did not differ between the groups. More patients in the bupivacaine group elected to go home on the day of surgery (p = 0.034). Narcotic usage was not significantly different.
Instillation of bupivacaine into port sites should be standard practice for elective laparoscopic cholecystectomy.
- SourceAvailable from: Ibrahim A Abdelazim[Show abstract] [Hide abstract]
ABSTRACT: To detect the effect of intra-peritoneal instillation of local anesthetic with or without NSAIDs on pain relief after gynecological laparoscopy.07/2012; 2(2). DOI:10.1016/S2305-0500(13)60136-0
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ABSTRACT: Postoperative pain control after laparoscopic ventral hernia repairs remains a significant clinical problem. We sought to determine the pain-sparing efficacy of local anesthetic infiltrated into the abdominal wall wounds created by the placement of transabdominal sutures used to ensure adequate fixation of the mesh during laparoscopic ventral hernia repair. Patients undergoing laparoscopic ventral/incisional hernia repair were randomized to receive local anesthesia (0.25% bupivacaine with epinephrine) into all layers of the abdominal wall to the level of the parietal peritoneum at suture fixation sites immediately before suture placement (Group I; n=9) or no local anesthesia (Group II, control; n=9). The anesthetic technique was otherwise standard for both groups. Postoperatively, pain was assessed with a 10-point visual analogue scale (VAS) at 1, 2, 4, and 24 hours. Analgesic use and hospital stay were also recorded. The groups were similar in age, sex, ASA, and size of hernia defect. The operative times were not statistically different between the 2 groups (Group I, 118+/-12 minutes; Group II, 144+/-21 minutes; P>0.05). Group I had a statistically significant decrease in the pain scores compared with Group II (2.2+/-0.8 vs. 6.4+/-0.9; P<0.05) at 1 hour postoperatively. At 2 and 4 hours, the mean pain scores were decreased but not statistically different. Similarly, the cumulative consumption of pain medication at 1, 2, and 4 hours postoperatively as well as the average hospital stay (Group I, 2.0+/-0.4; Group II, 2.4+/-0.4 days) were lower but not statistically significant in patients in Group I compared with those in Group II. This small, randomized study demonstrates that infiltration of suture fixation sites is effective in reducing early postoperative pain but not analgesic consumption following laparoscopic incisional and ventral hernia repairs. A larger study is required to investigate this strategy on later postoperative pain and hospital stay.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 10(3):345-50. · 0.79 Impact Factor
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ABSTRACT: Laparoscopic cholecystectomy is characterized by a short hospital stay. Hence, pain control on the day of surgery is increasingly important. The aim of this study was to evaluate the effect of intraperitoneal bupivacaine on pain relief following laparoscopic cholecystectomy. Sixty patients undergoing elective laparoscopic cholecystectomy were prospectively randomized into 2 groups. Following removal of the gallbladder, group A received 100 mg of bupivacaine in 50 cc of saline, installed into the gallbladder bed and right subphrenic space. Group B received saline without bupivacaine. Pain was assessed using a visual/analog scale at fixed-time intervals. No significant difference occurred in the average pain levels between the groups at 1, 2, 4, and 14 hours postsurgery. The average analgesic requirement was lower in the bupivacaine group, but this did not reach statistical significance. Application of intraperitoneal bupivacaine did not attenuate pain following laparoscopic cholecystectomy, and no role exists for its routine use.JSLS: Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons 03/2000; 4(4):301-4. · 0.79 Impact Factor