Efficacy of Intraperitoneal Bupivacaine on Postoperative Analgesia in Laparoscopic Cholecystectomy: A Meta-analysis

Abstract

Introduction: The analgesic effect of intraperitoneal bupivacaine has been widely studied, but with controversial results. Objective: To determine the efficacy of intraperitoneal bupivacaine on producing postoperative analgesia in patients who underwent laparoscopic cholecystectomy. Methods: A systematic literature search on the use of intraperitoneal bupivacaine in reducing postoperative pain was done using Medline and Cochrane. The search yielded 6 randomized controlled trials, involving a total of 440 patients. Mean differences in visual analog pain score at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery were pooled using random effects model. Results: Overall, there was a significant reduction of pain score in the bupivacaine group with VAS score of -0.55 cm (95% CI, -0.80 to -0.31). Subgroup analysis at 0, 2, 4, 6, 8, and 12 hours post-surgery showed statistically significant mean differences in the VAS score of -1.59 cm (95% CI, -2.31 to -0.86), -0.60 cm (95% CI, -1.02 to – 0.17), -0.80 cm (95% CI, -1.34 to -0.26), -0.85 cm (95% CI, -1.46 to -0.24), -0.64 cm (95% CI, -1.12 to -0.16), and -0.38 cm (95% CI, -0.68 to -0.08), respectively, in favor of the bupivacaine group. However, at 24 hours post-surgery, there was no statistically significant mean difference in the VAS score of -0.09 cm (95% CI, -0.49 to 0.31). Conclusion: Intraperitoneal bupivacaine instillation among patients undergoing laparoscopic cholecystectomy is effective in providing postoperative analgesia specifically in the first 12 hours post-op. Key words: intraperitoneal bupivacaine, bupivacaine, laparoscopic cholecystectomy, postoperative pain, pain