Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study

Barczyński, Marcin; Konturek, Aleksander; Herman, R. M.

doi:10.1007/s00464-005-0458-1

Cited by 83 publications

(65 citation statements)

References 31 publications

(30 reference statements)

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“…This may have introduced another limitation, however, since preemptive analgesia with peritoneal instillation of bupivacaine has been shown to provide superior analgesia. 19 It also appears that the analgesic benefits of NSAIDs can be optimized by continuous prophylactic administration. [20][21][22] Therefore, our patients may have experienced additional benefit if the ketorolac treatment had been extended and initiated preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Murdoch

Ramsey

Day

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Ketorolac is a parenterally active nonsteroidal anti-inflammatory drug with localized anti-inflammatory properties. We examine the postoperative analgesic efficacy of locally administered intraperitoneal (IP) ketorolac compared with intravenous (IV) ketorolac during laparoscopic cholecystectomy. Methods With institutional ethics approval, 120 patients undergoing elective laparoscopic cholecystectomy were randomized to receive intraoperative 1) IP ketorolac 30 mg ? intravenous saline (IP group), 2) intraperitoneal saline ? IV ketorolac 30 mg (IV group), or 3) intraperitoneal saline ? intravenous saline (Control group) under standardized anesthesia. The primary and secondary outcomes were postoperative fentanyl requirements in the postanesthesia care unit and the time to first analgesic request, respectively. Other outcomes examined included abdominal pain (at rest and with coughing), shoulder pain, nausea, vomiting, and any other postoperative complications.Results On average, patients receiving IP ketorolac required less (mean difference, 29 lg; 95% confidence interval [CI], 2 to 56; P = 0.04) fentanyl than patients in the Control group but a similar (mean difference, 16 lg; 95% CI, 12 to 43; P = 0.27) amount compared to patients in the IV group. There was an increase in the median (interquartile range

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Section: Discussionmentioning

confidence: 99%

Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Murdoch

Ramsey

Day

et al. 2016

Can J Anesth/J Can Anesth

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“…These results are comparable with studies conducted by Berczynski et al and Maestroni et al Maestroni et al also observed that pain was significantly less in patients who received ropivacaine as compared to saline before creation of pneumoperitoneum. 8,9 However, Lee et al concluded that no significant difference in abdominal pain occurred by preemptive instillation of Bupivacaine in laparoscopic cholecystectomy. 10 This lack of effect in their study might be due to small dosage of intraperitoneal Bupivacaine used (0.25% 40 ml) as compared to our study in which we used 0.5% Ropivacaine 3mg/kg The traditional approach to postoperative analgesia is to start therapy when surgery is completed and pain is experienced.…”

Section: Resultsmentioning

confidence: 99%

Comparison of intraperitoneal instillation of ropivacaine with normal saline in laparoscopic cholecystectomy

Bindra¹,

Chawla²,

Kumar³

et al. 2017

Int J Res Med Sci

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Background: Local anesthetics are now widely used, as they have a good safety profile and are available in long acting preparation. They provide the benefit of analgesia without systemic side effects that may result from use of enterally and parenterally administered drugs.Methods: This prospective randomized double-blind study was conducted on 100 patients with symptomatic gall stones disease undergoing laparoscopic cholecystectomy. Patients were randomized to receive either 0.5% of 3mg/kg of Ropivacaine diluted in 100 ml NS, instillation at intraperitoneal space before creation of pneumoperitoneum (group I) or 100 ml NS instillation at intra peritoneal space before creation of pneumoperitoneum (group II). VAS score for pain abdomen as well as shoulder were recorded postoperatively at various time intervals and compared in both the groups. Total analgesic consumption in 24hrs was also noted and compared.Results: The mean postoperative VAS score for abdomen and shoulder pain was significantly (p values<0.05) lower in group I than in group II till 24 hrs postoperatively. The latency time from end of operation to first analgesic requirement was significantly longer in group I than in group II.Conclusions: Intraperitoneal instillation of Ropivacaine before the creation of pneumoperitoneum significantly decreased the total abdominal pain, shoulder tip pain with lower analgesic consumption. As it is safe and without apparent side effects, we believe that intraperitoneal instillation of local anaesthetic in patients undergoing elective laparoscopic cholecystectomy is an effective modality for postoperative pain management.

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“…Some trials have preemptively used dextromethorphan {an NMDA (N-methyl-D-aspartate) receptor antagonist}, NSAIDS, opiods, epidural, and multimodal analgesia with positive results in reducing pain among patients (4,36,37). Other trials assessing the role of local anaesthetic given preemptively in the form of intraperitoneal instillation were also conducted where local anaesthetic agent were given intraperitoneally and compared with placebo or groups with instillation at the end of operation (31,(38)(39)(40). However, these techniques can only be conducted after extensive literature review and large-scale multi-centre trials since evidence of the use of these modalities does not appear to be supported by large number of evidence-based literatures (4,17).…”

Section: Discussionmentioning

confidence: 99%

Superior Somatic Pain Relief and Improved Visceral Pain Control Is Achieved Using Pre-Emptive Analgesia for Laparoscopic Cholecystectomy: A Randomized Controlled Trial

Ps¹,

Kh²,

Lucy³

et al. 2012

JUMMEC

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BACKGROUND:Laparoscopic cholecystectomy, although is less invasive than open surgery, is not completely pain free. The use of local anaesthesia to relieve pain following this procedure is a common practice. However, it remains debatable whether a pre-or post-operative drug administration is more effective. Here, we investigated the role of preemptive local anaesthetic infiltration given pre-or post-incisional, in relieving the pain during laparoscopic surgery.

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Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study

Cited by 83 publications

References 31 publications

Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Intraperitoneal ketorolac for post-cholecystectomy pain: a double-blind randomized-controlled trial

Comparison of intraperitoneal instillation of ropivacaine with normal saline in laparoscopic cholecystectomy

Superior Somatic Pain Relief and Improved Visceral Pain Control Is Achieved Using Pre-Emptive Analgesia for Laparoscopic Cholecystectomy: A Randomized Controlled Trial

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