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

Abstract

Local anesthetic instillation (ropivacaine rather than bupivacaine) at the end of laparoscopy prevents postoperative pain and dramatically decreases the need for morphine. This technique, compared with placebo, is safe, improves patient comfort, shortens the stay in the postoperative care unit and decreases nursing care in the ward.

Randomized trial of preemptive local analgesia in vaginal surgery

“…Initial human studies validated the premise of preemptive analgesia with initial application in inguinal herniorrhaphy [15]. Investigators also examined its efficacy in laparoscopic surgery with promising results [5][6][7][8][9][10]. With laparotomy, however, the effect of PLA was not observed [13,17].…”

“…Initial animal studies demonstrated that using anesthetic to block nerve fibers before trauma prevents hyperexcitability in the dorsal horn of the spinal cord, which is believed to be an important mechanism of central sensitization [1]. Existing literature, however, has noted conflicting results when this theory is applied clinically to postoperative pain management [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. Some authors have suggested that the effects of preemptive analgesia may vary according to the type of surgery [12].…”

A Placebo-Controlled Comparison of Bupivacaine and Ropivacaine Instillation for Preventing Postoperative Pain After Laparoscopic Cholecystectomy

“…The dose, concentration, site, and manner of administration were different and no consensus was apparent. Goldstein et al 12 found the morphine-sparing effect of ropivacaine (150 mg) was signifi cantly greater than that of bupivacaine (100 mg) after gynecologic surgery. On the other hand, in a recent study, the intraperitoneal instillation of ropivacaine during a laparoscopic cholecystectomy thus resulted in lower pain scores and in reduced morphine requirements in comparison to a placebo.…”

“…5 Intraperitoneal local anesthetic has been shown to reduce pain after laparoscopic gynecologic surgery. [12][13] Nevertheless, this technique seems to be controversial for pain relief after a laparoscopic cholecystectomy, because not all studies report similar results. 5 The comparative data on bupivacaine and ropivacaine have so far been sufficient.…”

Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy

“…The main advantages of this technique are its simplicity, safety, and low cost. Specifically, the use of local anesthetics for tissue infiltration, in combination with general anesthesia, has been investigated during laparoscopic cholecystectomy in several studies [4,8,14,17].…”