Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials

Abstract

With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of this systematic review was to appraise the clinical effects of this modality. Comprehensive searches were conducted independently without language restriction. Studies were identified from the following databases from inception to September 2009: Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Cochrane Library, Medline, PubMed, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINHAL). Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Thirty randomized controlled trials were identified for review. The clinical heterogeneity of IPLA use was high. However, there appeared to be reduced pain, opioid use, and need for rescue analgesia, and reduced postoperative cortisol and glucose responses. There is evidence in favor of IPLA in LC. Further trials of this modality in LC are not needed as these are unlikely to reduce clinical heterogeneity. IPLA should be trialled as future minimally invasive surgical techniques approach.