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

Abstract

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.

Effect of Intraperitoneal Ketamine as Postoperative Analgesia in Laparoscopic Cholecystectomy

“…Shoulder pain which results from phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Somatic pain due to small surgical incision, which has much less pain intensity (2) .…”

Peripherally applied opioids for postoperative pain: evidence of an analgesic effect? A systematic review and meta‐analysis

“…Data from 26 RCTs, including 42 comparisons, 1531 patients, and 13 different surgical interventions were analyzed . The range of numbers of patients included in the studies was 20–90.…”

“…For the meta‐analysis, 16 studies (21 comparisons) reported sufficient data on VAS scores, and data were extracted from graphs in nine studies. For the outcome time to first analgesic, five studies (10 comparisons) reported sufficient data.…”

“…Two studies, including two comparisons, were available for each of these surgical interventions, investigating the postoperative analgesic effect of interpleural sufentanil or fentanyl for thoracotomy, local infiltration with morphine or tramadol administered to the peritoneal cavity in relation to hysterectomy, addition of morphine to intravenous regional anesthesia for carpal tunnel surgery, and administration of morphine or a gelatin sponge soaked with morphine into the iliac crest harvest site (Table ). For gynecologic laparoscopy, two studies, including three comparisons, evaluated the analgesic effect of intraperitoneal morphine (Table ).…”

“…All included RCTs were of small or medium size potentially leading to biases. The design of the included studies can be divided into three groups: (1) studies comparing peripheral administration of opioid with the same dose of systemic opioid and with placebo, (2) studies comparing peripheral administration of opioids with the same dose of systemic opioid, and (3) studies comparing peripheral administration of opioids with placebo . More than half of the studies compared peripheral opioid with only a placebo group.…”