The Effects of Intraperitoneal Local Anesthetic on Analgesic Requirements and Endocrine Response After Laparoscopic Cholecystectomy: A Randomized Double-Blind Controlled Study

Abstract

This randomized double-blind placebo-controlled study was designed to evaluate the effects on postoperative pain of the local anesthetic, 0.5% bupivacaine with epinephrine, sprayed hepatodiaphragmatically under the surgeon's direct view during laparoscopic cholecystectomy. Metabolic endocrine responses to surgery (glucose and cortisol) and nonsteroidal anti-inflammatory drug requirements were investigated, as well as the presence of nausea, vomiting, and sweating. Local anesthetics or placebo solutions were given as follows. Immediately following the creation of a pneumoperitoneum, surgeons sprayed the first 20 mL of solution (S1), and an additional 20 mL of solution (S2) was sprayed at the end of the operation. Patients were classified into three groups (14 patients per group). Group A received 20 mL of saline during both S1 and S2, group B received 20 mL of saline during S1 and 20 mL of bupivacaine during S2, and group C received 20 mL of bupivacaine during both S1 and S2. The degree of postoperative pain was assessed using the visual analogue scale (VAS) and the verbal rating scale (VRS) on arrival in the recovery room and subsequently at time intervals of 4 h, 8 h, 12 h, and 24 h. The results of this study indicate a significant decrease of postoperative pain in patients treated with local anesthetic. VAS and VRS pain scores, as well as respiratory rate and analgesic requirements, were significantly lower in group C. The postoperative plasma cortisol level in group C was significantly lower than in groups A and B.

Pre‐emptive analgesia with local anaesthetic for herniorrhaphy

“…Our results are in contrast to those published by Pasqualucci and colleagues, who demonstrated preemptive analgesia with bupivacaine plus epinephrine when injected through the port during laparoscopic cholecystectomy [10]. Once again, median pain scores were low (VAS # 2/10) in both the presurgical and postsurgical groups despite statistical significance.…”

Acute postoperative pain relief, by intraperitoneal application of local anesthetics, during laparoscopic cholecystectomy

“…Our data also showed a signifi cant decrease in supplemental ketorolak in patients given morphine intraperitoneal. We used bupivacaine and low doses of morphine, intraperitoneally to achieve the additional analgesic benefi t from the combined eff ect of a local anesthetic with an opioid agonist (25)(26)(27)(28)(29). Intraperitoneal local anesthetics would be expected to be useful for treating visceral pain.…”

“…But, an important factor that limits recovery is postoperative pain. Intraperitoneal instillation of local anesthetics is a simple method of analgesia and should be considered in addition to other morphine sparing analgesics such as NSAIDs, acetaminophen and incisional local anesthetics (4,5). Laparoscopic cholecystectomy, in healthy patients is routinely performed at our hospital on a day case basis.…”

Effect of intraperitoneal bupivacaine on postoperative pain and sympathoadrenal response following laproscopic cholecystectomy

“…The choice was local anaesthetic was made on the basis of size of area involved in surgery, a volume of 20 ml was the minimum quantity required for coverage on all levels. 5,6,7 0.5% concentration of local anaesthetic was chosen after comparison of the experience listed in literature. 6 Sympatho-adrenal response was seen by doing blood sugar.…”