Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy

Choi, Geun Joo; Kang, Hyun; Baek, Chong Wha; Jung, Yong Hun; Kim, Dong Rim

doi:10.3748/wjg.v21.i47.13386

Cited by 56 publications

(37 citation statements)

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“…[23] Laparoskopik kolesistektomilerde peritrokal lokal anestezik infiltrasyonu, [17,18] peritoneal boşluğa loakl anestezik uygulaması, [24] subdiafragmatık alana lokal anestezik, [19,25] peritrokal ve peritoneal alana birlikte lokal anestezik uygulaması [26,27] ile ağrının azaltılmasını amaçlayan çeşitli çalışmalar gerçekleştirilmesine rağmen sonuçlar çelişkilidir. Choi ve ark., [28] bir meta-analiz araştırmasında; laparoskopik kolesistektomilerde İPLA uygulamasının postoperatif dönemde istirahatteki viseral abdominal ve omuz ağrısını azalttığını ancak istirahatteki parietal ağrıyı ve hareket halindeki abdominal ağrıyı azaltmadığını tesbit etmişlerdir.…”

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“…meta-analiz çalışmalarında yara infiltrasyonu ile parietal ağrının azalmadığını saptamışlardır. [28] Das ve ark., [32] İPLA infiltrasyonunun laparoskopik kolesistektomilerde erken postoperatif dönemde ağrı skorlarını anlamlı şekilde azalttığı bildirilmiştir. Bizim çalışmamızda da erken dönemdeki ağrı skorları İPLA uygulananlarda daha düşük idi.…”

Section: Discussionunclassified

“…Bu çalışmada aynı zamanada İPLA uygulamasının omuz ağrısının insidensi ve şiddetini azalttığı gösterilmiştir. [28] Bizim çalışmamızda da tüm gruplarda omuz ağrısı düşük VAS ile birlikte idi.…”

Section: Discussionunclassified

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The Analgesic efficacy of Intraperitoneal, Incisional, Intraperitoneal+Incisional Levobupivacaine in laparoscopic gynaecological surgery.

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2019

Agri

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Çalışmamızda, laparoskopik jinekolojik cerrahide intraperitoneal, insizyonel ve intraperitoneal+insizyonel levobupivakainin analjezik etkinliğini araştırmayı amaçladık. Gereç ve Yöntem: Grup 1'de 20 ml levobupivakain intraperitonal olarak, Grup 2'de 20 ml levobupivakain trokarların insizyon bölgesine, Grup 3'de ise 20 ml levobupivakain intraperitoneal uygulanırken, trokar insizyon bölgelerine de 20 ml levobupivakain infiltre edildi. Postoperatif 2., 4., 12. ve 24. saatlerde hastaların omuz ağrısı, istirahat ve hareketle ortaya çıkan karın ağrısı VAS ile değerlendirildi. VAS >3 olarak değerlendirilen hastaların analjezisi yetersiz olarak kabul edildi ve diklofenak sodyum uygulandı. Olguların postoperatif ilk analjezik gereksinim zamanı, toplam analjezik tüketimi, analjezik etkinlik ve analjezik yöntemden memnuniyetleri değerlendirildi. Bulgular: Gruplar arasında VAS skorlarında anlamlı farklılık yoktu (p>0.05). Grup 2'deki hastalarda, Grup I ve Grup III'deki hastalara göre postoperatif analjezik tüketimi daha fazla ve ilk analjezik gereksinim zamanı daha kısa idi, fakat fark anlamlı değildi. Hastaların uygulanan anestezik yöntemden memnuniyetleri gruplar arasında benzerdi. Sonuç: Jinekolojik laparoskopik cerrahilerde intraperitoneal levobupivakain uygulamalarının sadece cilt insizyonuna levobupivakain uygulanan gruba göre istatistiksel olarak anlamlı olmasa da daha az omuz ve karın ağrısı, daha düşük total analjezik tüketimi ve daha etkin bir analjezi ile alternatif bir yöntem olabileceğini düşünmekteyiz. Ancak, konu ile ilgili farklı lokal anestezikleri de karşılaştıran daha ileri çalışmalara ihtiyaç vardır.

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The Analgesic efficacy of Intraperitoneal, Incisional, Intraperitoneal+Incisional Levobupivacaine in laparoscopic gynaecological surgery.

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2019

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“…Several manifestations of laparoscopic cholecystectomy related postoperative pain were described: Visceral pain related to tissue injury and stretching of nerve endings, parietal pain related to port sites and referral shoulder pain related to stretching and irritation of the diaphragm by carbon dioxide gas [8, 9]. Ways to minimize postoperative pain might thus be a restricted number and size of ports [10] or the avoidance of residual pneumoperitoneum at the end of the procedure [9].…”

Section: Discussionmentioning

confidence: 99%

Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

et al. 2016

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BackgroundImmediate laparoscopic cholecystectomy is the accepted standard for the treatment of acute cholecystitis. The aim of the present study was to evaluate the feasibility of a standardized approach with tailored care maps for pre- and postoperative care by comparing pain, nausea and patient satisfaction after elective and emergent laparoscopic cholecystectomy.MethodsFrom January 2014 until April 2015, data on pain and nausea management were prospectively recorded for all elective and emergency procedures in the department of visceral surgery. This prospective observational study compared consecutive laparoscopic elective vs. emergency cholecystectomies. Visual analogue scales (VAS) were used to measure pain, nausea, and satisfaction from recovery room until 96 hours postoperatively.ResultsFinal analysis included 168 (79%) elective cholecystectomies and 44 (21%) emergent procedures. Demographics (Age, gender, BMI and ASA-scores) were comparable between the 2 groups. In the emergency group, patients did not receive anxiolytic medication (0% vs.13%, p = 0.009) and less postoperative nausea and vomiting (PONV) prophylaxis (77% vs. 97% p = <0.001). Perioperative pain management was similar in terms of opioid consumption (median amount of fentanyl 450ug [IQR 350-500] vs. 450ug [375-550], p = 0.456) and wound infiltration rates (24% vs. 25%, p = 0.799). Postoperative consumption of paracetamol, metamizole and opiod medications were similar between the 2 groups. VAS scores for pain (p = 0.191) and nausea (p = 0.392) were low for both groups. Patient satisfaction was equally high in both clinical settings (VAS 8.5 ± 1.1 vs. 8.6 ± 1.1, p = 0.68).ConclusionsA standardized pathway allows equally successful control of pain and nausea after both elective and emergency laparoscopic cholecystectomy.This study was retrospectively registered by March 01, 2016 in the following trial register: www.researchregistry.com (UIN researchregistry993)Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0194-6) contains supplementary material, which is available to authorized users.

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“…15 Choi GJ et al have also concluded that intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain. 16 …”

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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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Effect of intraperitoneal local anesthetic on pain characteristics after laparoscopic cholecystectomy

Abstract: Intraperitoneal local anesthetic as an analgesic adjuvant in patients undergoing laparoscopic cholecystectomy exhibited beneficial effects on postoperative abdominal, visceral, and shoulder pain in a resting state.

Cited by 56 publications

References 51 publications

The Analgesic efficacy of Intraperitoneal, Incisional, Intraperitoneal+Incisional Levobupivacaine in laparoscopic gynaecological surgery.

The Analgesic efficacy of Intraperitoneal, Incisional, Intraperitoneal+Incisional Levobupivacaine in laparoscopic gynaecological surgery.

Is standardized care feasible in the emergency setting? A case matched analysis of patients undergoing laparoscopic cholecystectomy

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

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