The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures- a pilot study

Abstract

Although laparoscopic surgery is known to cause less postoperative pain when compared to laparotomy, some patients still suffer from excessive pain, especially during the first stages of recovery. The purpose of our study was to assess the effect of intraperitoneal nebulization of lidocaine during gynecological laparoscopic procedures on perioperative pain. The study was a prospective, randomized, double-blinded, placebo-controlled trial (Canadian task force classification I) that included 23 patients who underwent outpatient gynecological laparoscopic procedures. Patients were randomly assigned either to a study group that received 5 mg/kg of lidocaine intraperitonealy during surgery (n=15) or to a control group that received sterile water in the same manner (n=8). The fluid was infuslated along with the CO 2 through a Insuflow® device. All patients received the same anesthetic technique. Intraoperative pain as assessed by changes in the vital signs was treated with fentanyl. Postoperative pain was evaluated according to postoperative opioid requirements and by the Visual Analogue Scale (VAS) at 15 min, 1 h and 24 h postoperatively. The VAS score was found to be lower for the study group 1 h after surgery (p=0.023). There was no difference in the VAS scores at 15 min (p=0.9) and 24 h (p=0.11) after surgery. A correlation analysis showed no association between the amount of lidocaine insufflated and the severity of the postoperative pain. There was no difference in terms of fentanyl administration during surgery or opiod consumption following surgery between the groups. We concluded that continuous intraperitoneal insuflation of lidocaine using an Insuflow® device may significantly reduce pain in the initial stage of postoperative recovery.

Description of a novel approach for intraperitoneal drug delivery and the related device

“…Alkhamesi et al [10] showed that nebulized heparin and hyaluronic acid attenuates peritoneal tumor growth after laparoscopic surgery in a rodent mode. Sharon et al [11] examined the effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures in a limited number of patients. Druckrey-Fiskaaen et al [12] examined laparoscopic spray application of fibrin sealant effects on hemodynamics and spray efficiency at various application pressures and distances.…”

Bupivacaine use with the Insuflow® device

“…Interestingly, dissemination of the results from our work has produced some disagreement, and as mentioned in our article, one study has found that lidocaine administered with the Insuflow Ò device did reduce pain 1 h after laparoscopic surgery [2]. We agree with you that hot evaporation-based devices such as Insuflow Ò are unable to transport local anesthetic and have proved the in vivo consequences, or lack thereof, clinically.…”

Pain reduction by continuous intraperitoneal nebulization of ropivacaine during gynecological laparoscopic surgery

“…Our current study is a follow-up to two previous studies that were published by our group [6,19]. All three studies analyzed the effect of continuous nebulization of local anesthetics throughout the laparoscopic procedure, from initiation of CO 2 insufflation.…”