Effect of Presurgical Local Infiltration of Levobupivacaine in the Surgical Field on Postsurgical Wound Pain in Laparoscopic Gynecological Surgery

Abstract

ients undergoing laparoscopic surgery require close attention to providing adequate pain management. This randomized, double-blind, controlled study was designed to determine whether infiltrating the surgical field preoperatively with levobupivacaine, which is as effective as bupivacaine but causes fewer cardiovascular and central nervous system problems, would reduce the frequency, intensity, and duration of postsurgical wound pain in women treated for benign gynecologic disorders. Thirty-seven women undergoing laparoscopic surgery for benign conditions received an injection of 7 mL of a solution containing 5 mg/mL levobupivacaine 15 minutes before skin incision, whereas 37 others received the same volume of physiological saline. All incisional sites were infiltrated. An open laparoscopy technique with open step-by-step access was used for laparoscopy. Pain intensity was estimated using a 10-point visual analog scale 6, 12, and 24 hours postoperatively. The 2 groups were similar with regard to demographic and intraoperative characteristics. Mean pain intensity was significantly lower in the levobupivacaine group than in control patients 6 and 12 hours after surgery. Actively treated patients required less analgesia postoperatively, and the mean time to ambulation was significantly less than in control subjects. Women treated with levobupivacaine also had a shorter mean postoperative stay, but this difference was not statistically significant. Postoperative pain after laparoscopic gynecologic surgery, performed under general anesthesia, is substantially less—especially in the first 12 hours—if the surgical field is exposed preoperatively to levobupivacaine solution. Patients managed in this way require less postoperative analgesia.