Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy

Hérnández-Palazón, J; Tortosa, J. A.; Rosa, V. Nuño de la; Giménez-Viudes, J.; Ramírez, Grettel Montero; Robles, R

doi:10.1017/s0265021503001431

Cited by 36 publications

(38 citation statements)

References 24 publications

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“…Previous studies agree that postoperative pain from laparoscopy consists of three components, visceral, parietal, and referred shoulder pain distinguishing from each other in the intensity, latency, and duration. [2]…”

Section: Discussionmentioning

confidence: 99%

“…Visceral pain has its maximum intensity during the first hour and is exacerbated by coughing, respiratory movements, and mobilization. [2]…”

Section: Discussionmentioning

confidence: 99%

“…[5] Administration of lipophilic opioid (Fentanyl or Meperidine) in the peritoneal cavity provides better analgesia. [2]…”

Section: Discussionmentioning

confidence: 99%

“…Combinations of intraperitoneal local anesthetic with many opioids have been studied in the past. [2] This prospective study was conducted to evaluate the analgesic efficacy of intraperitoneal bupivacaine and morphine after laparoscopic gynecological surgeries. To improve the reliability of results we have compared the main group, i.e., bupivacaine plus morphine with two other groups, one where bupivacaine was alone instilled and the other control group where saline was instilled.…”

Section: Introductionmentioning

confidence: 99%

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Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

2013

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Background:Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries.Methods:A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM (n=30): 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO (n=30) 30 ml 0.25% bupivacaine and in group C (n=30) 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS (0-100), for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted.Results:Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain (VAS: 23.33±6.04 vs. 45.5±8.57). It also reduces pain at 4 hours after surgery in the BM group (VAS 24±12.13 vs. 41.17±7.27 in the BO group). The time of administration of first rescue analgesic was significantly higher in the BM group (6.15 hours) compared to the BO group (4.51 hours). The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group.Conclusion:Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events.

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Section: Discussionmentioning

confidence: 99%

“…Visceral pain has its maximum intensity during the first hour and is exacerbated by coughing, respiratory movements, and mobilization. [2]…”

Section: Discussionmentioning

confidence: 99%

“…[5] Administration of lipophilic opioid (Fentanyl or Meperidine) in the peritoneal cavity provides better analgesia. [2]…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

2013

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“…[1] Pain after laparoscopic cholecystectomy is affect by several factors including patient demographics, nature of underlying disease, surgical factors, volume of residual gas, type of gas used for pneumoperitoneum, and the pressure created by the pneumoperitoneum. [13–18] A number of techniques have been described for reducing postlaparoscopy pain including: Preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%;[19] intraperitoneal ropivacaine and a gas drain;[20] intraperitoneal levobupivacaine with epinephrine;[21] intraperitoneal application of bupivacaine plus morphine;[22] preincisional injection of bupivacaine;[23] pre-emptive intraperitoneal injection of ropivacaine;[24] and intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam. [25] It is suggested that post-laparoscopic cholecystectomy pain is multifactorial and methods for short term analgesia cannot improve postoperative functions or shortened hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

et al. 2013

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Background:Laparoscopic cholecystectomy is associated with shorter hospital stay and less pain in comparison to open surgery. The aim of this study was to evaluate the effect of intraperitoneal hydrocortisone on pain relief following laparoscopic cholecystectomy.Methods:Sixty two patients were enrolled in a double-blind, randomized clinical trial. Patients randomly received intraperitoneal instillation of either 250 ml normal saline (n=31) or 100 mg hydrocortisone in 250 ml normal saline (n=31) before insufflation of CO2 into the peritoneum. Abdominal and shoulder pain were evaluated using VAS after surgery and at 6, 12, and 24 hours postoperatively. The patients were also followed for postoperative analgesic requirements, nausea and vomiting, and return of bowel function.Results:Sixty patients completed the study. Patients in the hydrocortisone group had significantly lower abdominal and shoulder pain scores (10.95 vs 12.95; P<0.01). The patients were similar regarding analgesic requirements in the recovery room. However, those in the hydrocortisone group required less meperidine than the saline group (151.66 (±49.9) mg vs 61.66 (±38.69) mg; P=0.00). The patients were similar with respect to return of bowel function, nausea and vomiting. No adverse reaction was observed in either group.Conclusion:Intraperitoneal administration of hydrocortisone can significantly decrease pain and analgesic requirements after laparoscopic cholecystectomy with no adverse effects.

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Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy

Rutherford

Massie

Worsley

et al. 2021

Cochrane Database of Systematic Reviews

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Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy

Cited by 36 publications

References 24 publications

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Intraperitoneal hydrocortisone for pain relief after laparoscopic cholecystectomy

Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy

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