Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis

Abstract

Preemptive administration of local anesthetic at the incision site reduces postoperative pain compared with placebo but achieves an analgesic effect similar to that of postincisional anesthetic infiltration. Preemptive local anesthetic administered intraperitoneally decreases postoperative pain compared with both placebo and postoperative infiltration. Surgeons should use local analgesia in laparoscopic surgery to decrease postoperative pain, but the timing of administration is significant only for intraperitoneal infiltration.

Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy

“…A similar form and frequency of monitoring was described by other authors [17,46,63]. Usage of local anesthetics can significantly reduce pain after LC [10,15,44]. Similar results are apparent in the present trial.…”

“…The timing of application of local anesthetic can be immediately before or at the conclusion of operation [33,34,[39][40][41][42][43]. Coughlin et al [44] in their systematic review and meta-analysis found that pre-operative and post-operative use of local anesthetic at the portsite incision had the same effect as pre-operative intraperitoneal application of local anesthetic-all leading to significant reduction in pain after LC when compared to placebo. This study was designed to apply the local anesthetic in a dose, volume, location, and manner in which an unambiguous effect could be ascertained-direct application to the cystic plate upon laparoscopic excision of the gallbladder.…”

Intraperitoneal and intravenous lidocaine for effective pain relief after laparoscopic appendectomy: a prospective, randomized, double-blind, placebo-controlled study

“…Many clinicians have demonstrated that intraperitoneal instillation of local anesthetic reduces postoperative pain and the need for analgesic medications [22][23][24]. A recent meta-analysis reported that preemptive intraperitoneal instillation of local anesthetic can be recommended, which is in line with the concept that the operative period is of particular importance for the pain sensitization process [25,26]. However, it is always a burden to perform extra procedures and to maintain constant instillation under circumstances of panperitonitis, loculated peritoneal fluid collections, and whenever analogous environments are present in the operation field.…”

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

“…Other studies argue for the importance of administration from the beginning of the procedure in order to gain a potential preemptive analgesic effect. Coughlin and colleagues performed a meta-analysis of studies comparing preemptive intraperitoneal administration of LA with postoperative instillation [17]. They showed that preemptive administration significantly reduces pain following laparoscopy.…”