A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy

Szem, Jeffrey W.; Hydo, Lynn J.; Barie, Philip S.

doi:10.1007/s004649910011

Cited by 97 publications

(62 citation statements)

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“…11,[23][24][25] Present study are consistent with Cunniffe MG et al who showed a significant decrease in shoulder tip pain after intraperitoneal bupivacaine using subdiaphragmatic administration of 80ml bupivacaine 0.125% plus epinephrine l/200,000 had no significant effect on total pain, parietal pain, visceral pain, or shoulder-tip pain as compared with saline. 26 Zmora and Elfberg demonstrate postoperative pain reduction with intraperitoneal bupivacaine after laparoscopic cholecystectomy, while Cunniffe have noted only reduced shoulder pain with overall pain not affected.…”

Section: Rt Shoulder Painsupporting

confidence: 88%

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

Gupta¹,

Rai²,

Vasuniya³

et al. 2018

Int Surg J

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Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following LC.Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.

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Section: Rt Shoulder Painsupporting

confidence: 88%

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

Gupta¹,

Rai²,

Vasuniya³

et al. 2018

Int Surg J

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“…However, pain also plays a major role in the metabolic and endocrine response, and is instrumental in the impairment of postoperative pulmonary function. Various methods have been investigated for reducing postoperative pain, such as local anesthesia [15] , intraperitoneal infiltration of local anesthesia [16] , preoperative administration of anti-inflammatory drugs [17] , utilizing CO2 at body temperature, applying intrapleural morphine [18] , and combined use of NSAIDs and opioids [19] . Our findings indicated that infiltrating ropivacaine after surger y through the port site reduced pain intensity, the number of patients requiring postoperative analgesics, and hospital stay.…”

Section: Discussionmentioning

confidence: 99%

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

Liu

Yeh²,

Lee³

et al. 2009

WJG

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AIM:To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery. METHODS:From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups. RESULTS:There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay. CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients.

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“…[7,8] Local anesthetic infiltration is often used to improve pain relief after laparoscopic cholecystectomy. [5,[9][10][11][12][13] The postoperative analgesic effect of intraperitoneal administration of local anesthesia after laparoscopic gynecologic surgery has proved to be effective and safe but there is lack of consensus regarding the dose, concentration, site, and manner of administration. [14][15][16][17][18] But the effect of the same procedure during laparoscopic cholecystectomy is controversial, and the reported results range from considerable pain reduction to no significant pain reduction.…”

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confidence: 99%

Comparison Of Analgesic Effects Of Intraperitoneal Lornoxicam And Ropivacaine Administration In Laparoscopic Cholecystectomy.

Memedov¹,

Menteş²,

Şimşek³

et al. 2008

TUTFD

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Objectives:In this randomized prospective study, we investigated the effects of lornoxicam vs. ropivacaine for the management of postoperative pain in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods:Patients were randomized into three groups and received 150 mg (80 mL) ropivacaine or 16 mg lornoxicam (80 mL) or placebo (80 mL saline) via multi-regional intraperitoneal instillation and port sites infiltration. Patient-controlled analgesia (PCA) device was used. Tramadol 50 mg tolerable dose, 5 mg/hour basal infusion, bolus dose 20 mg, locked 30 min, 4 hour limit were applied as 200 mg. Postoperative pain was assessed with 100-mm visual analog scale (VAS) at rest, while coughing, and during mobilization. Pain scores were recorded in the post-anesthesia care unit, and at 2, 4, 8, 12,18 and 24 h after the surgery. Results:At 24 h, VAS scores at rest and while coughing were found significantly lower in ropivacaine and lornoxicam group when compared with control group (p=0.047). The percentage of patients needing tramadol was significantly lower with ropivacaine and lornoxicam compared with control (p<0.001, p=0.018). There was no statistically significant difference between ropivacaine and lornoxicam group.Conclusion: Multi-regional, intraperitoneal instillation and port site infiltration of ropivacaine and lornoxicam during laparoscopic cholecystectomy reduces the postoperative pain.Key words: Laparoscopic cholecystectomy; ropivacaine; lornoxicam; postoperative pain.Amaç: Prospektif randomize olarak yapılan bu çalış-mada laparoskopik kolesistektomi sonrası ağrı tedavisinde lornoksikam ve ropivakainin etkisi araştırıl-mıştır. Hastalar ve Yöntemler:Çalışmaya dahil edilen 45 hasta üç gruba randomize edildi. Hastalara 150 mg (80 mL) ropivakain, 16 mg lornoksikam (80 mL) ve plasebo (80 mL saline) intraperitoneal olarak püskürtüldü ve port böl-gelerine infiltre edildi. Ameliyat bitiminde hasta kontrollü analjezi cihazı ile tramadol 50 mg yükleme dozu, 5 mg bazal infüzyon, bolus doz 20 mg, kilitli kalma süresi 30 dk, 4 saatlik limit 200 mg olarak planlandı. Hastaların ağrısı görsel analog skala (VAS) ile 0-100 olacak şekilde istirahat, öksürük sonrası ve mobilizasyon sırasında değerlen-dirildi. Ağrı skorları ilk saatte anestezi derlenme odasında ve 2., 4., 8., 12., 18., 24. saatlerde serviste değerlendirildi. Bulgular:Ropivakain ve lornoksikam grubunda istirahat ve öksürük sonrası VAS değerleri kontrol grubuna göre daha düşük bulundu (p=0.047). Tramadol tüketimi açısından, ropivakain ve lornoksikam grupları arasın-da fark bulunmazken (p>0.05), kontrol grubuna göre bu iki grupta anlamlı düşük olarak bulundu (p<0.001, p=0.018). Ropivakain ve lornoksikam grubu arasında ise istatistiksel olarak anlamlı fark bulunmadı.Sonuç: Ropivakain ve lornoksikamın port bölgelerine, intraperitoneal çoklu bölgeye laparoskopik kolesistektomi sonrası infiltrasyonu ameliyat sonrası ağrı tedavisinde etkin olarak bulunmuştur.Anahtar sözcükler: Laparoskopik kolesistektomi; ropivakain; lornoksikam; ameliyat sonrası a...

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A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy

Abstract: Intraperitoneal bupivacaine offered a detectable, albeit subtle benefit to patients undergoing LC. However, the effect was transient and had little impact upon the patient's convalescence.

Cited by 97 publications

References 23 publications

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

Comparison Of Analgesic Effects Of Intraperitoneal Lornoxicam And Ropivacaine Administration In Laparoscopic Cholecystectomy.

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