Intravenous Local Anesthetic Compared With Intraperitoneal Local Anesthetic in Laparoscopic Colectomy

Abstract

Introduction: Controlling perioperative pain is essential to improving patient experience and satisfaction following surgery. Traditionally opioids have been frequently utilized for postoperative analgesia. Although they are effective at controlling pain, they are associated with adverse effects, including postoperative nausea, vomiting, ileus, and long-term opioid dependency. Following laparoscopic colectomy, the use of intravenous or intraperitoneal infusions of lidocaine (IVL, IPL) are promising emerging analgesic options. Although both techniques are promising, there have been no direct, prospective randomized comparisons in patients undergoing laparoscopic colon resection. The purpose of this study was to compare IPL with IVL. Methods: Double-blinded, randomized controlled trial of patients undergoing laparoscopic colonic resection. The 2 groups received equal doses of either IPL or IVL which commenced intra-operatively with a bolus followed by a continuous infusion for 3 days postoperatively. Patients were cared for through a standardized enhanced recovery after surgery program. The primary outcome was total postoperative opioid consumption over the first 3 postoperative days. Patients were followed for 60 days. Results: Fifty-six patients were randomized in a 1:1 fashion to the IVL or IPL groups. Total opioid consumption over the first 3 postoperative days was significantly lower in the IPL group (70.9 mg vs 157.8 mg P < 0.05) and overall opioid consumption during the total length of stay was also significantly lower (80.3 mg vs 187.36 mg P < 0.05. Pain scores were significantly lower at 2 hours postoperatively in the IPL group, however, all other time points were not significant. There were no differences in complications between the 2 groups. Conclusion: Perioperative use of IPL results in a significant reduction in opioid consumption following laparoscopic colon surgery when compared to IVL. This suggests that the peritoneal cavity/compartment is a strategic target for local anesthetic administration. Future enhanced recovery after surgery recommendations should consider IPL as an important component of a multimodal pain strategy following colectomy.

Postoperative Pain Management in Children Undergoing Laparoscopic Appendectomy: A Scoping Review

“…Lidocaine appeared to have a transient analgesic effect. This may be due to the fact that the drug is designed to cause temporary loss of sensory, motor, and autonomic functions when injected or applied near nervous tissue [ 48 ]. Although intraperitoneal use of local anesthetics for postoperative pain in children may have no clinical benefit, on the contrary, it has been found to reduce total opioid consumption and pain score throughout the hospital stay in adults [ 47 ].…”

“…In this study, it was recommended that laparoscopic appendectomy be treated with long-term analgesia. In addition, laparoscopic appendectomy was known to be a low-risk operation [ 48 ]; however, the desire for a multimodality approach to treatment has been shown to be essential [ 49 ]. However, it is necessary to control inflammatory factors in the periphery, the surgical procedure itself produces an increase in inflammation, which is the cause of the procedure.…”

Introduction of day-case robotic liver surgery: a case series from a tertiary hepatobiliary and pancreatic centre

“…Other measures to improve post-operative pain could also be considered as part of a pathway particularly for cases that involve resection more than one lesion. Options may include the application of intra-peritoneal local anaesthetic, which has been shown to reduce pain and opioid consumption following major laparoscopic abdominal resection surgery [20,21].…”

Thermodynamic and spectroscopic evaluation of the eutectic mixture of myristic acid and the local anaesthetics, bupivacaine and ropivacaine

“…In recent years, the need for opioid sparing analgesics in postoperative pain management has become glaringly obvious with local anesthetics (LAs) emerging as safe and efficient alternatives. [1][2][3] The amide type LAs, bupivacaine and ropivacaine, prevent depolarization of sodium channels by binding to their intracellular domains and inhibiting neural transmission of pain signals. 4,5 Bupivacaine is most frequently used for continuous epidural and other regional analgesia techniques due to its long duration of action and a favorable ratio of sensory to motor neural block.…”