Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass

Abstract

IntroductionObesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain.MethodsIn this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0–10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded.ResultsAerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group.ConclusionThe aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain.

Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures

“…Five studies were suitable for meta‐analysis. These were in fundoplication20, 21, Roux‐en‐$\font\ss=cmss10 scaled 1000 \hbox{Y}$ bypass22, 23 and gastric banding24.…”

Does Preincisional Infiltration with Bupivacaine Reduce Postoperative Pain in Laparoscopic Bariatric Surgery?

“…There are numerous recent randomized studies of bariatric patients handled with other strategies proposed to diminish postoperative pain such as bupivacaine pump systems, intraoperative or continuous intraperitoneal bupivacaine application, systemic lidocaine, ultrasound-guided transversus abdominis plane block, etc. [13,[25][26][27][28][29]. These studies render different results, not always reproducible by other authors and expensive to apply in clinical practice in some cases.…”

“…Symons et al achieved reduction in postoperative oral narcotic use, with no differences in pain scores or outcome variables between the groups [26]. Alkhamesi et al, in contrast, reported lower pain scores in the treatment group, while maintaining similar levels of postoperative rescue medication use [27]. A study by Cottam et al showed that continuous postoperative subfascial/subcutaneous infusion of bupivacaine via subcostal catheters allowed switching patientcontrolled meperidine to oral analgesics quicker in the treatment group while maintaining similar pain scores as in the control group [13].…”

Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

“…It may be combined with pre-incision infiltration [165]. Efficacy of its use has also been demonstrated in bariatric surgery [166] and ropivacaine or levobupivacaine seem to be more effective than short-acting agents, like lidocaine [167]. Recently, it was reported that ultrasound-guided transversus abdominal plane block is feasible and safe in bariatric surgery [168] but data from RCTs comparing this technique with local anaesthetic infiltration are lacking.…”