Anesthesia (17)

Abstract

Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo‐controlled comparison of bupivacaine and ropivacaine. (Hotel‐Dieu Hospital, Paris, France) Anesth Analg 2000;91:403–407. This study tested the hypothesis that local anesthetics instilled at the end of laparoscopic gynecologic procedures are able to prevent postoperative pain at wake‐up and during the first 24 h. A total of 180 patients were randomly assigned into three groups to receive an intraperitoneal instillation of 20 mL of either bupivacaine 0.5% (Group B), ropivacaine 0.75% (Group R) or saline (Group S) at the end of surgery. All patients received analgesia with acetaminophen and ketoprofen IV infusions. Pain was assessed by using a 0‐10 graded numerical scale (NS) every 5 min in the postanesthesia care unit and IV morphine was administered if NS was> 4. Assessment of pain continued every 4 h on the ward, and subcutaneous morphine was injected if needed to keep the NS score <4. Postoperative nausea and vomiting (PONV) was rated on a 4‐point scale. The morphine consumption at wake‐up and over the first 24 h was significantly lower (P<0.05) in Group B (mean, 0.92 mg at wake‐up; 3.08 mg over 24 h) and in Group R (mean, 0.25 mg at wake‐up; 0.69 mg over 24 h), than in Group S (mean, 4.18 mg at wake up; 12.93 mg over 24 h). The morphine‐sparing effect of ropivacaine was significantly greater than that of bupivacaine. Both local anesthetics were effective in the prevention of PONV. Conclude that local anesthetics should be instilled in all gynecologic patients at the end of all laparoscopic procedures.

The Effect of Pre-Emptive Administration of Dextromethorphan on Postoperative Pain in Patients Undergoing Interval Laparoscopic Tubal Sterilization

“…Subphrenic/ shoulder pain is the first type of pain, and may persist until the third to fourth postoperative day (Alexander, 1997;Dobbs et al, 1987;Goldstein et al, 2000;Guard & Wiltshire, 1996). None of the patients in this study reported this type of pain.…”

“…However, the incidence of reported abdominal pain probably encompasses these two types of pain. In the literature this pain has been reported to last no more than six hours, and can often be prevented or at least decreased by the topical administration of 0.5% bupivacaine, as was done in this study (Ezeh et al, 1995;Goldstein et al, 2000;Wheatley, Millar, & Jadad, 1994). By the time the bupivacaine had worn off, this pelvic pain would have largely subsided.…”

“…This would be consistent with previous studies that have shovm removal of insufflation gas at the end of procedure to greatly reduce this type of pain. Deep pelvic pain is the second type of pain, and rarely lasts for more than six hours postoperatively (Alexander, 1997;Chi & Cole, 1979;Davis & Miller, 1988;Dobbs et al, 1987;Goldstein et al, 2000;Pelland, 1987). None of the patients in this study reported deep pelvic or spasmodic/cramping pain.…”

“…The review of literature supported the analgesic effectiveness of this technique in the immediate postoperative period and I elected to standardize its use in this study as part the multimodal approach to postoperative pain (Ezeh et al, 1995;Goldstein et al, 2000;Wheatley et al, 1994).…”