Abstract
Background: The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. Methods: A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. Results: The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine—n = 4, 20%; 0.5% levobupivacaine—n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). Conclusion: A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine.
Highlights
A varicocele represents an abnormal enlargement of the veins within the pampiniform plexus and has been recognized as one of the most frequent causes of infertility in men, with an incidence in the pediatric population of 10–15% [1]
Visual Analogue Scale (VAS) pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine, or the patients from the control group in whom no local anesthetic was applied (p < 0.001) (Figure 3)
The study results proved that operative site-local anesthesia significantly improves postoperative pain immediately after and up to 24 h after the procedure and reduces the postoperative analgesic consumption [16]
Summary
A varicocele represents an abnormal enlargement of the veins within the pampiniform plexus and has been recognized as one of the most frequent causes of infertility in men, with an incidence in the pediatric population of 10–15% [1]. The usual modality of treatment, with a very high success rate, is surgical varicocelectomy. Several surgical approaches for successful varicocele treatment are available, including open inguinal, subinguinal microscopic laparoscopic, and robotic-assisted laparoscopic ligation [1,2,3,4]. The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy
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