Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy

Abstract

Background: Laparoscopic hysterectomy is now an established operation, as it is less invasive and carries much less post-operative pain compared to open hysterectomy. However, post-laparoscopy analgesia is still a challenge. Intraperitoneal (IP) instillation of local anaesthetics has been shown to minimize postoperative pain after laparoscopic surgeries. This study was conducted to evaluate the efficacy of IP instillation of dilute analgesia prior the end of laparoscopic hysterectomy to reduce postoperative pain. The primary outcome was to assess postoperative pain scores. Secondary outcomes included assessment of postoperative analgesic requirements (type, amount, and timing), and frequency of nausea and vomiting.Methods: 20 cases were enrolled for laparoscopic hysterectomy and were divided randomly into two groups, Group A: 10 cases, where IP analgesia (Bupivacaine and Magnesium Sulphate) was instilled -under vision- prior removal of trocars, and Group B: 10 cases, where no IP analgesia was used. After surgery, Visual Analogue Score (VAS) was recorded at 6, 12, 24 hours and 7 days. Postoperative analgesic requirements (type, amount, and timing), and frequency of nausea and vomiting were also recorded.Results: The overall VAS during the first postoperative 24 hours was significantly lower in group A (P = 0.048, 0.049, and 0.003 at 6, 12, and 24 hours after surgery). Time to first of analgesia required (in hours) was longer (6.0±1.41 vs 3.20±1.48, P = 0.004) and total analgesic consumption (in mg) was lower (2.40±0.89 vs 3.30±0.67, P = 0.047) in group A compared to group B. The need for opioids was also significantly less in group A (3 cases vs 8 cases, P = 0.024). in group A, nausea and vomiting were less reported as well (P = 0.040).Conclusions: The instillation of local IP dilute analgesia is an effective and safe method for reducing pain after laparoscopic hysterectomy.

Effect of intravenous versus intraperitoneal magnesium sulfate on hemodynamic parameters and postoperative analgesia during laparoscopic sleeve gastrectomy–A prospective randomized study

“…This may be attributed to blocking of visceral pain conduction; in addition, absorption from the large peritoneal surface may also contribute to analgesia. [151617]…”

Randomized control trial of intra-peritoneal instillation of bupivacaine versus placebo for post-operative analgesia after laparoscopic hysterectomy

“…32 Badawy et al reported significantly lower VAS in Bupivacaine and Magnesium Sulphate group at 6, 12 and 24 hours after laparoscopy than a placebo group, while difference was insignificant after 7 days. 3 A significant reduction in pain intensity was noted in bupivacaine and magnesium sulphate group.…”

“…Badawy et al noted a significant increase in the time required for 1st analgesia in bupivacaine and magnesium sulphate group than without instillation group, also the amount of analgesia needed was significantly less in study group than comparison group, and number of patients need for opioids in were more in group receiving no any intraperitoneal instillation than compared to patients receiving instillation of bupivacaine and magnesium sulphate. 3 The range of total opioid medication use did not differ significantly in study group compared to placebo group by Arden et al 25 The amount of rescue opioid fentanyl required was lower in bupivacaine dexmedetomidine (BD) group and bupivacaine clonidine (BC) group compared to only bupivacaine group. BC group required less amount of fentanyl when compared to BD group.…”

“…Effective pain control encourages early ambulation, which significantly reduces the risk of deep vein thrombosis and pulmonary embolism; enhances patient's ability to take deep breaths to decrease the risk of pulmonary complications (e.g., atelectasis and pneumonia); and decreases the incidence of tachycardia and unnecessary investigations related to it. 3 Intraperitoneal instillation of local anesthetics, with or without adjuncts, has become a popular way to manage postlaparoscopic pain. 32 The present study was aimed to compare the efficacy of intraperitoneal instillation of bupivacaine versus placebo for post-operative analgesia after laparoscopic hysterectomy.…”

“…Carbon dioxide is another factor for diaphragmatic irritation 2) somatic component of post laparoscopy is pain due to holes made in abdominal wall for trocars entry. 3 Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. A high quality of postoperative pain management improves recovery and reduces the risk of postoperative acute and chronic adverse effect.…”