Reduction of early postoperative pain after diagnostic laparoscopy with local bupivacaine: a randomized placebo controlled study|
Ashraf M. N. Refaie, Mowafy M. Khatab
Objective: To evaluate the effects of preincisional infiltration and intraperitoneal instillation of bupivacaine on early relief of pain after diagnostic laparoscopy.
Design: Randomized, placebo, controlled-double blind study
Setting: University teaching hospital.
Materials and methods: Sixty three women with unexplained infertility, for whom diagnostic laparoscopy was performed under general anesthesia. Preincisional infiltration at the trocar sites and intraperitoneal instillation of bupivacaine were used in the patient group (group I) which included 32 patients, and same volumes of physiologic saline were given at the same sites to control group (group II) which included 31 patients. Modified McGill pain intensity score was used to assess the postoperative pain.
Main outcome measures: Pain scores at 1,2 and 3 hours postoperatively, percent of patients who needed further analgesia, percent of patients discharged 2 hours after the procedure and time to first analgesia.
Results: Pain scores at 1, 2 and 3 hours postoperatively were significantly lower for group I than group II (P < 0.05). The percent of patients who needed further analgesia was significantly lower in group I compared with group II (P < 0.05). The percent of patients discharged 2 hours after the operation also was significantly higher in group I than group II (P <0.05%). The time to first analgesia was significantly longer in group I (P <0.05).
Conclusion: Bupivacaine infiltration into the trocar sites and instillation into the peritoneal cavity is beneficial for patients undergoing diagnostic laparoscopy. The effect of these drugs is temporary, but they can significantly decrease early postoperative pain and reduce the need for additional analgesics. Most important, the rate at which patients can be discharged from the hospital only 2 hours after surgery is increased significantly.
Diagnostic laparoscopy, postoperative pain relief, local anesthetics