(312/756): Aerosolized bupivacaine reduces post-laparoscopic pain: A randomized controlled double blinded clinical trial

Abstract

The introduction of laparoscopic strategies in the management of intra-abdominal pathologies has initiated a new philosophy in surgery centred on minimising the biological insult of surgical intervention. Laparoscopy has been shown to offer significant healthcare benefits over conventional approaches, including reduction of inflammatory and neuroendocrine responses and adhesion formation. Of particular interest are reports of decreased postoperative pain, resulting in shorter hospital stays and earlier return to normal activity; however, many patients still require strong analgesia postoperatively. The aetiology of this pain remains unclear, although the initiation of pneumoperitoneum has been implicated. Further reduction in postoperative pain would clearly be of advantage. In this study, we have analysed the use of intra-operatively delivered aerosolized intraperitoneal bupivacaine and its ability to reduce postoperative pain. The study is a prospective randomized controlled double blind trial. Eighty patients undergoing laparoscopic cholecystectomy were recruited and divided randomly into 4 groups: control (n=20), aerosolized Bupivacaine (n=20), aerosolized normal saline (n=20) and local Bupivacaine into the bladder bed (n=20). All the patients had standard preoperative, intraoperative and postoperative care including anaesthesia and analgesia. Pain score was carried out by the nursing staff in recovery and 6hrs, 12hrs, and 24hrs postoperatively using a standard 0-10 pain scoring scale. In addition opiate consumption and oral analgesia were recorded. Aerosolized bupivacaine significantly reduced postoperative pain in comparison to all other treatments (p<0.05). Spraying of bupivacaine into the gall bladder bed appears to reduce pain but with no statistical significant from control. Aerosolized intraperitoneal local anaesthetic is a very effective method to control postoperative pain and it significantly help to abolish opiate use and help in rapid mobilisation leading to short hospitalization and less cost. The introduction of laparoscopic strategies in the management of intra-abdominal pathologies has initiated a new philosophy in surgery centred on minimising the biological insult of surgical intervention. Laparoscopy has been shown to offer significant healthcare benefits over conventional approaches, including reduction of inflammatory and neuroendocrine responses and adhesion formation. Of particular interest are reports of decreased postoperative pain, resulting in shorter hospital stays and earlier return to normal activity; however, many patients still require strong analgesia postoperatively. The aetiology of this pain remains unclear, although the initiation of pneumoperitoneum has been implicated. Further reduction in postoperative pain would clearly be of advantage. In this study, we have analysed the use of intra-operatively delivered aerosolized intraperitoneal bupivacaine and its ability to reduce postoperative pain. The study is a prospective randomized controlled double blind trial. Eighty patients undergoing laparoscopic cholecystectomy were recruited and divided randomly into 4 groups: control (n=20), aerosolized Bupivacaine (n=20), aerosolized normal saline (n=20) and local Bupivacaine into the bladder bed (n=20). All the patients had standard preoperative, intraoperative and postoperative care including anaesthesia and analgesia. Pain score was carried out by the nursing staff in recovery and 6hrs, 12hrs, and 24hrs postoperatively using a standard 0-10 pain scoring scale. In addition opiate consumption and oral analgesia were recorded. Aerosolized bupivacaine significantly reduced postoperative pain in comparison to all other treatments (p<0.05). Spraying of bupivacaine into the gall bladder bed appears to reduce pain but with no statistical significant from control. Aerosolized intraperitoneal local anaesthetic is a very effective method to control postoperative pain and it significantly help to abolish opiate use and help in rapid mobilisation leading to short hospitalization and less cost.