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:10.1097/00003643-200311000-00006

Cited by 49 publications

(12 citation statements)

References 24 publications

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“…However, a study by Stuhldreher et al concluded that intraperitoneal local anesthetic instillation did not improve postoperative pain scores or opioid requirements in patients undergoing laparoscopic colorectal procedures [16]. Indeed, other previous studies reported little additional benefit to intraperitoneal bupivacaine on pain scores beyond 2 h postoperatively [17], or indeed no benefit at all [18]. Systematic reviews have pooled the results of trials investigating the role for intraperitoneal instillation of local anesthetic.…”

Section: Discussionmentioning

confidence: 99%

Aerosolized Intraperitoneal Local Anesthetic for Laparoscopic Surgery: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Aerosolized Intraperitoneal Local Anesthetic for Laparoscopic Surgery: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

et al. 2015

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“…Another study done by Hernandes-Pazon et al 26 showed that intraperitoneal administration of local anaesthetic in combination with an opioid reduced the analgesic requirements during first 6 postoperative hours.…”

Section: Discussionmentioning

confidence: 96%

Analgesic Efficacy of Intraperitoneal Tramadol vs. Placebo for Postoperative Pain Relief Following Laparoscopic Appendicectomy: A Double Blinded One Year Randomized Control Trial: Single Centric, Hospital Based Study

Pratap¹,

Bellad²

2016

jemds

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CONTEXTEarly postoperative pain is common and predominant complaint which results in prolonged hospital stay. AIMSThe present study explores effectiveness of intraperitoneal instillation of tramadol on postoperative pain relief and emergence of adverse effects following laparoscopic appendectomy. SETTINGS AND DESIGNThe present one year double blinded randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum, from January 2014 to December 2014. METHODS AND MATERIALA total of 60 patients undergoing elective laparoscopic appendectomy were enrolled. The selected patients were divided into two groups of 30 each as group A and B based on the drugs that is intraperitoneal tramadol 150 mg (Diluted in 40 mL of normal saline) and 40 mL of intraperitoneal normal saline respectively. STATISTICAL ANALYSIS USEDThe categorical data was expressed as rates, ratios and percentages and comparison was done using Fisher's exact test and chisquare test. Continuous data was expressed as mean±standard deviation and the comparison was done using independent sample 't' test. A probability ('p' value) of less than or equal to 0.05 at 95% confidence interval was considered as statistically significant. RESULTSIn group A, 53.33% of the patients were males compared and 46.67% in group B (p=0.606). The mean age in group A (26.13±9.96 years) and group B (31.43±14.81 years) were comparable (p=0.110). Both the groups were comparable in terms of demographic characteristics, clinical presentation and vitals (p>0.050). The mean VAS scores at beginning were significantly low in group A (1.53±0.94) compared to group B (2.93±1.17) and similar trend was noted at all the durations through the post-operative period (p<0.001). Most of the patients in group A did not request for the post-operative analgesia (56.67% vs 6.67%; p=0.011). In group A, significantly lower numbers of mean doses were administered (0.57±0.82 vs 2.20±0.92; p<0.001). The frequency of postoperative rescue analgesia significantly low in group A at 15 minutes, 30 minutes, 6 hours and 12 hours as compared to group B (p<0.050). Adverse events were noted in 23.33% of the patients with group A compared to 10% in group B (p=0.166). The mean hospital stay in group A was significantly low (p=0.017). CONCLUSIONSIntraperitoneal instillation of tramadol offers effective post-operative visceral pain relief in laparoscopic appendectomy and incidence of adverse effects is well acceptable. KEYWORDSIntraperitoneal Instillation; Laparoscopic Appendectomy; Post-Operative Pain; Tramadol. HOW TO CITE THIS ARTICLE:Pratap V, Bellad AP. Analgesic efficacy of intraperitoneal tramadol vs. placebo for postoperative pain relief following laparoscopic appendicectomy: a double blinded one year randomized control trial: single centric, hospital based study.

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“…33 Postoperative pain after laparoscopic cholecystectomy consists of three components, visceral, parietal and referred shoulder pain distinguishable from each other in intensity, latency and duration. 34 Previous studies 35,36 suggest that predominant cause of pain is parietal, but in contrast many other studies emphasised that in early convalescent period major portion is occupied by visceral pain because as compared to small incisions and limited trauma to the abdominal wall, the surgical manipulation and tissue destruction in visceral organs is much more. 37,38,39 Multimodal efforts like parenteral opioids, non-steroidal antiinflammatory drugs or local wound infiltration have been done to reduce overall pain and benefit postoperative conditions of patients undergoing laparoscopic surgeries.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal Bupivacaine Alone With Dexmedetomidine or Tramadol for Postoperative Analgesia Following Laparoscopic Cholecystectomy- A Comparative Evaluation

Ali¹,

Ommid²,

Alamgir³

et al. 2017

jemds

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BACKGROUNDPost laparoscopic cholecystectomy patients complain more of visceral pain as a result of stretching of the intra-abdominal cavity, peritoneal inflammation and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Intraperitoneal instillation of local anaesthetic agents has become an important method to control postoperative pain, nausea, vomiting and reduced hospital stay. The purpose of this double-blinded randomised controlled trial was to compare the analgesic efficacy of intraperitoneal instillation of local anaesthetic agents alone or in combination with opioids, ∝-2 agonists such as clonidine and dexmedetomidine to reduce postoperative pain following laparoscopic cholecystectomy. MATERIALS AND METHODS135 were equally divided into three, allocated to one of the groups by random allocation cards using computer generated random numbers. Group A (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + 5 mL normal saline (NS); Group B (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + tramadol 1 mg/kg (diluted in 5 mL NS); or Group C (n= 45): Intraperitoneal bupivacaine 30 mL 0.25% + dexmedetomidine 1 mcg/kg (diluted in 5 mL NS). RESULTSWe found bupivacaine in combination with tramadol (Group B) has significantly lower VAS score at all points of time (P < 0.001) and overall VAS score and postoperative analgesia was statistically lower than with Group A. But bupivacaine + dexmedetomidine had even better VAS score underlying high efficacy of drug. Time to first request of analgesia in postoperative period was significantly delayed in Group C as compared to Group A (P= 0.86). CONCLUSIONWe conclude that intraperitoneal instillation of dexmedetomidine 1 mcg/kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and significantly reduces the analgesic requirement in postoperative period as compared to bupivacaine 0.25% alone and may be better than bupivacaine combined with tramadol.

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

Cited by 49 publications

References 24 publications

Aerosolized Intraperitoneal Local Anesthetic for Laparoscopic Surgery: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

Aerosolized Intraperitoneal Local Anesthetic for Laparoscopic Surgery: A Randomized, Double‐Blinded, Placebo‐Controlled Trial

Analgesic Efficacy of Intraperitoneal Tramadol vs. Placebo for Postoperative Pain Relief Following Laparoscopic Appendicectomy: A Double Blinded One Year Randomized Control Trial: Single Centric, Hospital Based Study

Intraperitoneal Bupivacaine Alone With Dexmedetomidine or Tramadol for Postoperative Analgesia Following Laparoscopic Cholecystectomy- A Comparative Evaluation

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