Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine

Goldstein, Andrei; Grimault, Patrick; Henique, Aude; Keller, Michèle; Fortin, Anne; Daraı̈, Émile

doi:10.1213/00000539-200008000-00032

Cited by 44 publications

(50 citation statements)

References 17 publications

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“…However, we found a low incidence of shoulder pain in all treatment groups, because the residual intraperitoneal carbon dioxide was defl ated carefully by the surgeon. Our study shows that the intraperitoneal administration of bupivacaine is eff ective aft er LC, as noted in other reports, although the amount of pain reduction and duration of eff ect were limited (16)(17)(18)(19). It has been suggested that the poor results in pain reduction, when intraperitoneal local anesthesia is used, aft er LC -compared with those in the available gynecological literature -are due to visceral and parietal pain being more severe than shoulder pain aft er LC (20)(21)(22)(23)(24).…”

Section: Discussionsupporting

confidence: 86%

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Ivanov

Veljkova

2011

JHSCI

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Introduction: Intraperitoneal administration of local anesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported after laparoscopic cholecystectomy. This study aimed to assess the analgesic effect of the intraperitoneal administration of bupivacaine and morphine, in patients undergoing laparoscopic cholecystectomy. Methods: 90 patients (30 patients in each group) were included in a double blind, randomized manner. At the end of laparoscopic cholecystectomy, the patients were intraperitoneally treated with 30 ml of: physiological saline (Group 1) or 0.25% bupivacaine (Group 2) or 0.25% bupivacaine + 2 mg morphine (Group 3). Patient's postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of Ketorolak, administered by intravenous or intramuscular route. Pain, vital signs, supplemental analgesics consumption and side effects were recorded for all patients for 12h. Results: There were no difference between the three groups, regarding pain scores (et rest and coughing) during the study, except in the fi rst 6 h, when scores were lower for patients receiving intraperitoneal bipuvacaine + morphine (p<0.05). Conclusions:In the patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of bupivacaine + morphine, reduced the analgesic requirements during the fi rst 6 postoperative hours compared with the control groups. The combination of intraperitoneal bupivacaine 0.25% and morphine was more effective for treatment of pain after laparoscopic cholecystectomy.

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Section: Discussionsupporting

confidence: 86%

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Ivanov

Veljkova

2011

JHSCI

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“…Intraperitoneal administration of local anaesthetics has been evaluated for several different laparoscopic procedures [25][26][27][28][29]. It is based on the theory that the instillation of local anaesthetics in the peritoneal cavity blocks the visceral afferent signalling, thereby resulting in reduced nociception [30].…”

Section: Discussionmentioning

confidence: 99%

Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review

2013

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Due to the well-known advantages of minimal invasive surgery, the majority of procedures for benign gynaecological diseases are performed by laparoscopy. Although laparoscopic surgery results in improved patient satisfaction, a considerable portion of patients have complaints of post-operative shoulder pain. This review presents an overview of the currently evaluated techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic review was conducted using Medline, Embase and Cochrane databases. Randomised clinical trials reporting techniques to reduce shoulder pain after laparoscopic gynaecologic procedures for benign diseases were included. Eighty-eight articles were screened for inclusion. A total of 15 articles were included in the final review. The following studies described the techniques used to reduce shoulder pain: six studies evaluated the effect of local anaesthetics, three studies evaluated the effect of pulmonary recruitment manoeuvre and three studies evaluated the effect of intraperitoneal drainage. The remaining three studies evaluated the effect of saline installation, minilaparoscopy and gasless laparoscopy by using the Laprolift®. Overall, the pulmonary recruitment manoeuvre and intraperitoneal drainage were found to reduce the incidence and severity of shoulder pain (SP). Based on the current evidence, safety and possibility to implement the technique in daily practice, pulmonary recruitment manoeuvre can be recommended to reduce both the incidence and severity of SP.

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“…18 In another study by Callesen et al, combined port site and mesosalpinx infiltration and peritoneal instillation by using 285 mg of ropivacaine (50 mL) in a double-blind, randomized, placebo-controlled study on 80 patients undergoing laparoscopic tubal sterilization, have demonstrated similar efficacy. 19 Many other clinical trials have studied pain relieving after gynaecologic laparoscopy, namely laparoscopic hysterectomy.…”

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confidence: 92%

Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy

Badawy

2017

Int J Reprod Contracept Obstet Gynecol

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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.

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Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gynecologic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine

Cited by 44 publications

References 17 publications

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review

Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy

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