Postoperative pain control after microlaparoscopy in patients with infertility: a prospective randomized study

Abstract

Objective: To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of lidocaine and trocar site infiltration of bupivacaine to minimize postoperative pain after diagnostic microlaparoscopy performed under local anesthesia with conscious sedation. Design: Prospective randomized study. Setting: Day-surgery unit of Endogyn Service, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy. Patient(s): Sixty-one women with infertility. Intervention(s): All patients received local anesthesia and conscious sedation before surgery. After the microlaparoscopy, the treatment group was given 40 mL of intraperitoneal subdiaphragmatic 0.5% lidocaine and 5 mL of 0.5% bupivacaine that was infiltrated into the trocar insertion sites. The control group received no treatment. When necessary, ketoprofene or ketorolac were administered IM after surgery. Main Outcome Measure(s): Postoperative pain was evaluated with the use of a visual analog scale with scores ranging from 1–10 immediately after surgery and over the next 48 hours. The rate at which patients were discharged from the hospital 2 hours after surgery also was recorded. Result(s): The treatment group had significantly lower pain scores both immediately after surgery and 1, 3, and 6 hours afterward. The need for postoperative analgesics also was significantly lower in the treatment group. The rate at which patients were discharged 2 hours after surgery was significantly higher in the treatment group. Conclusion(s): Postoperative intraperitoneal lidocaine administration and bupivacaine infiltration of the trocar sites is beneficial for patients undergoing microlaparoscopy. The effect of these drugs is temporary, but they can significantly decrease postoperative pain for approximately 6 hours 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.