Effectiveness of local anesthetic on postoperative pain in different levels of laparoscopic gynecological surgery

Abstract

Lidocaine infiltration at port sites had beneficial effects on pain intensity in the early postoperative period after laparoscopic gynecological surgery. However, the results of present study showed that the analgesic effect mechanism of local anesthetic was unrelated to the preemptive analgesia hypothesis.

A Randomized Controlled Trial on Efficacy and Safety of Trocar-Site Infiltration with Lidocaine for Postoperative Pain Relief after Diagnostic Laparoscopy

“…A possible reason for this peculiar and unexpected finding could be that at the point the patients received the post-incision injections; the analgesic effects of lidocaine may not be apparent because of other concomitant analgesics used intraoperatively by the anesthetist. This finding was quite in contrast to the findings of 2 prior studies by Selcuk et al [15] and Lam et al [16]. While Selcuk et al [15] documented that preclosure analgesia (lidocaine infiltration at the port-sites before closure of port-site incision) was better than preemptive analgesia (lidocaine infiltration at the port-sites before port-site incision) and no analgesia in reducing post-operative wound pain, another study by Lam et al [16] documented that either the preclosure lidocaine infiltration or preemptive lidocaine infiltration was more effective on postoperative pain intensity than its placebo groups in laparoscopic surgery.…”

“…This finding was quite in contrast to the findings of 2 prior studies by Selcuk et al [15] and Lam et al [16]. While Selcuk et al [15] documented that preclosure analgesia (lidocaine infiltration at the port-sites before closure of port-site incision) was better than preemptive analgesia (lidocaine infiltration at the port-sites before port-site incision) and no analgesia in reducing post-operative wound pain, another study by Lam et al [16] documented that either the preclosure lidocaine infiltration or preemptive lidocaine infiltration was more effective on postoperative pain intensity than its placebo groups in laparoscopic surgery. Lam et al [16] further revealed that the pain score at 24 h in the preclosure group was significantly lower than that in the preemptive group.…”

“…The addition of epinephrine to lidocaine would have been a better study regimen, as it tends to prologs the effects. Injection of the lidocaine was performed after surgery and so it has been established that preclosure analgesic techniques may be superior to preemptive analgesia before the skin incision for postoperative pain control [15,17]. Although it is important to distinguish between those interventions that always cost time and money and those that are cost-effective, this could not be assessed in this present study.…”

“…Women in the preemptive group only showed significantly lower pain scores at 2 h than the placebo group [16]. However, this mechanism of lower pain score post operatively (at 24 h) in the preclosure group could not be explained, as the elimination half-life of lidocaine is approximately 90-120 min [15,16].…”

“…While the use of trocar-site infiltration with lidocaine has been examined for the prevention of postoperative pain following laparoscopic surgery [15,16], none has been studied exclusively for diagnostic laparoscopy and dye test without additional procedures. Other previous studies have only evaluated the effects of injection of lidocaine intravenously [17] or intraperitoneally [18] or both [19].…”