Dath D, Park AE: Randomized, controlled trial of bupivacaine injection to decrease pain after laparoscopic cholecystectomy
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.
Available from: Ibrahim A Abdelazim
- "Intraperitoneal local anesthetic has been shown in some studies to reduce postoperative pain following laparoscopic surgery but the effect seems to be transient   . "
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ABSTRACT: Objective: To detect the effect of intra-peritoneal instillation of local anesthetic with or without NSAIDs on pain relief after gynecological laparoscopy. Methods: Seventy five patients scheduled for laparoscopy were included in the study and randomly divided into three groups. At the end of the laparoscopic procedure, 100 mL normal saline in the first group, or 100 mL normal saline contains 200 mg lidocaine in the second group, or 100 mL normal slaine containing 200 mg lidocaine and 20 mg tenoxicam in the third group were splashed into the pelvis by the surgeon. Post-operative pain were monitored and compared. Results: The incidence and severity of immediate postoperative shoulder pain reduced from 44% of patients scoring 2-5 in saline group to 16% scoring 2-3 in lidocaine group and 8% scoring 2-3 in lidocaine-tenoxicam group. Compared with saline group, abdominal pain scores were significantly lower in lidocaine group and lidocaine-tenoxicam group over 24 hours after surgery. At 12 and 24 hours after surgery, abdominal pain scores were significantly reduced in lidocaine-tenoxicam group compared with lidocaine group. No pain on deep respiration was reported in 84%, and 68% in lidocaine-tenoxicam and lidocaine groups respectively compared to 12% in those in the saline group. The mean time to first request for analgesia was increased from (2.3 ±1.9) hours in saline group to (4.4 ± 2.4) hours in lidocaine group and to (8.3 ± 10.2) hours in lidocaine-tenoxicam group. Conclusion: Intraperitoneal balanced analgesia (local anesthetics ± NSAIDS) is a simple and safe technique for analgesia following gynaecological Laparoscopy.
Available from: Danny Rosin
- "The pain characteristics suggest an intra-abdominal origin, and it seems unlikely that this pain is generated mainly by the small skin incisions. Studies of local anesthetics infiltrated into the skin wounds report reduced postoperative pain only to a minor degree.6,7 Pain may be generated by stretching of the abdominal wall duringthe pneumoperitoneum, by the local dissection, or by irritation of the peritoneum from blood, bile spillage, or by the CO2 used for creation of the pneumoperitoneum. "
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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.
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ABSTRACT: Previous work has demonstrated that intraperitoneal (i.p.) lidocaine may provide analgesia after laparoscopic cholecystectomy. The aim of this prospective, randomized, double-blind study was to compare pain relief, recovery variables, and side effects after i.p. instillation of lidocaine plus tenoxicam given either i.v. or i.p. after laparoscopic cholecystectomy.
Ninety patients were randomly allocated to one of three groups to receive either 200 ml normal saline i.p. and 2 ml of normal saline i.v. (saline group), 200 ml lidocaine 0.1% i.p. and 2 ml tenoxicam 20 mg i.v. (tenoxicam i.v. group), or 200 ml lidocaine 0.1% with 20 mg tenoxicam i.p. and 2 ml of normal saline i.v. (tenoxicam i.p. group). The i.p. instillation was made under the right diaphragm and on the gall bladder bed. VAS pain scores at rest, on movement and during coughing, were measured 2, 4, 6, 12, and 24 h after operation. The time to first demand of analgesia, total analgesic requirement, recovery variables, and side effects were investigated.
In the tenoxicam i.p. group, pain scores were significantly lower both at rest and on movement and analgesic consumption was reduced compared with the saline group (P<0.05). In the tenoxicam i.v. group, pain scores at rest were significantly lower compared with the saline group. Although recovery of bowel function was significantly faster in the tenoxicam i.p. group (P<0.05), there were no differences in any other recovery characteristics or incidence of nausea between the groups.
Combination of intraperitoneal lidocaine and tenoxicam provided better analgesia on movement, and faster return of bowel function compared with i.p. lidocaine and i.v. tenoxicam during the 24 h period after surgery.
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