A Systematic Review and Meta-Analysis of Intraperitoneal Bupivacaine in Laparoscopic Gynecologic Surgery

Abstract

Objective: We set out to evaluate whether the instillation of bupivacaine versus a saline solution into the peritoneal cavity at time of laparoscopic gynecologic surgery will reduce postoperative pain and postoperative opioid consumption. Data Sources: We searched six databases: Web of Science, SCOPUS, Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE and PubMed. Our search strategy had no restriction on time or languages and included all studies that met our search algorithm up to March of 2021. Methods of Study Selection:We included only randomized trials that met our search strategy for the outcomes of 1) pain intensity 24 hours after surgery, 2) pain intensity 6 hours after surgery, and 3) length of hospital stay. Tabulation, Integration, and Results: We analyzed continuous data using mean difference (MD) with relative 95% confidence interval (CI). We included 8 randomized clinical trials. We found that intraperitoneal bupivacaine showed significant difference from the saline group regarding pain intensity 24 hours after surgery (MD= −0.73 [−1.10, −0.36]) (P = 0.01) and pain intensity 6 hours after surgery (MD= −1.12 [−2.22, −0.02]) (P = 0.05). Overall, patients allocated to the placebo group seemed to need other analgesics earlier than patients allocated to the bupivacaine group (MD=145. 08 [51.37, 238.79] (P = 0.02)). There was no significant difference regarding the length of hospital stay (MD= −0.44 [−1.44, 0.56]) (P = 0.39). Conclusion: Bupivacaine significantly reduced the visual analog pain score for pain compared with that of the placebo at 6 and 24 hours postoperatively. There was no significant difference in hospital stay. Prospero Registration: CRD42021254268.

Comparative Study Between Early versus Late Intraperitoneal Administration of Either Bupivacaine/Tramadol or Bupivacaine/Dexmedetomidine for Perioperative Analgesia in Abdominal Laparoscopic Cancer Surgeries: A Prospective Randomized Study

“…Investigating the effect of intraperitoneal instillation of local anesthetics has proven its efficacy in improving perioperative pain and reducing opioid consumption. 7 Combination of local anesthetics with additives results in better analgesic outcome. Dexmedetomidine is a sedative analgesic drug that is used as an adjuvant to reduce anesthetic and analgesic requirements.…”

“…2 , 5 Few studies reported the effectiveness of intraperitoneal (IP) administration of some drugs for pain relief after laparoscopic surgery. 6 , 7 Published studies are heterogeneous and often lack appropriate controls, so definitive conclusion cannot be made regarding its value and effectiveness.…”

Efficacy and safety of intraperitoneal dexamethasone on postoperative nausea and vomiting following laparoscopy: study protocol for a systematic review and meta-analysis

“…Dexamethasone contributes to reducing the risk of PONV following laparoscopic surgery and is usually administered by intravenous injection according to previous research on PONV prophylaxis 15 16. Recently, an uncommon delivery method of intraperitoneal injection has emerged in clinical practice, and many studies on this delivery method have mainly focused on the field of intraperitoneal local anaesthetics for postlaparoscopic analgesia 17–19. However, some studies documenting the use of intraperitoneal glucocorticoids have reported an association with a lower incidence of PONV after laparoscopic surgery 20 21.…”