The Effect of Subcutaneous and Intraperitoneal Instillation of Local Anesthetics on Postoperative Pain after Laparoscopic Varicocelectomy: A Randomized Controlled Trial

Abstract

Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine—n = 4, 20%; 0.5% levobupivacaine—n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine.

The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial

“…Pre-emptive analgesia can be used to prevent a pain signal from the surgical wound starting from the very first skin incision. These findings have been confirmed in previously published studies on pre-emptive analgesia in different surgical conditions [ 11 , 12 , 13 ]. The aim of this double-blinded, randomized, placebo-controlled trial was to determine whether children undergoing otolaryngological procedures (adenoidectomy, tonsillectomy, or adenotonsillectomy) benefit from pre-emptive analgesia in the postoperative period.…”

Urology in Pediatrics

“…Zenon Pogorelic and colleagues performed a randomized controlled trial on the effect of subcutaneous injection at trocar incision sites and intraperitoneal instillation of local anesthetics on postoperative pain after laparoscopic varicocelectomy in adolescents. Compared to the control group, the level of postoperative pain was significantly lower in patients who received local anesthetics intraoperatively [7].…”

Total Intravenous Anesthesia with Ketofol versus Combination of Ketofol and Lidocaine for Short-Term Anesthesia in Pediatric Patients; Double Blind, Randomized Clinical Trial of Effects on Recovery

“…A randomized, double-blind, placebo-controlled study in which 36 adult patients underwent breast cancer surgery exhibited a decrease in the incidence and intensity of chronic pain following the procedures, with the use of perioperative intravenous lidocaine (bolus of IV lidocaine 1.5 mg/kg followed by continuous infusion of lidocaine at 1.5 mg/kg/h). It is well-known that application of lidocaine at the site of surgical incision reduces postoperative pain [ 23 ], but clinical evaluations suggested that the use of intravenous lidocaine therapy in this way has beneficial effects on pediatric postoperative pain, the opioid demand and the sense of well-being of children, especially during the 24 h postoperatively [ 24 ]. Sun et al published a meta-analysis of randomized controlled trials where they explored the use of systemic lidocaine for postoperative analgesia and recovery after abdominal surgical procedures [ 25 ].…”