RCT – comparing bupivicaine administration in laparoscopic gynecologic surgery using either a pre-incision or post-closure injection

Abstract

To determine whether pre- or post-incision local Bupivicaine administration is preferable in reducing post-operative pain among women undergoing laparoscopic gynecologic surgery for benign indications. SETTING: Academic tertiary medical center. Randomized clinical trial. 27 patients were enrolled in this prospective, randomized, patient and anesthesiologist-blinded study. In consenting patients having 2 lower abdominal trocars placed, patient's were randomized into 2 groups. One group received pre-incision Bupivicaine on the left incision while the right received Bupivicaine only after closure of the incision at the end of the procedure. The other group was randomized to the opposite side Bupivicaine administration. PRIMARY OUTCOME: Pain scale at the right and left incision sites as measured by the Wong-Baker FACES pain rating scales (1-5) on post operative days (POD) 0, 1 and 2. All incisions received a total of 5ml Bupivicaine during surgery. Both groups were similar in terms of age, BMI and number of port sites. Pain was reported to be similar in both sides in the pre incision Bupivicaine injection group when compared with the post incision group. The average Wong Baker scores were found to be 1.6 on POD0, 1.9 on POD1 and 0.85 on POD2. Patients in both groups reported taking similar number of post operative analgetic pills.Tabled 1Bupivicaine PRE IncisionBupivicaine POST ClosureP-valuePost op day 01.675±1.391.6±1.420.8379Post op day 12±0.971.85±1.450.7263Post op day 21±1.60.75±0.650.5RandomizationRight side - pre (N=17)Left side - pre (N=10)Age30.92±7.2533.6±5.790.2895BMI24.33±3.8730±5.290.1794Number of 5mm lateral trocars22 Open table in a new tab Our study suggest that in laparoscopic gynecologic surgery for benign indications, pre- or post-incision Bupivicaine administration at the incision site will yield similar pain relief in the first 72 hours post surgery.