Intraperitoneal Bupivacaine Research Articles

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial

​Haematobiochemical Changes during Pain Management with Intraperitoneal Bupivacaine and Bupivacaine-dexmedetomidine in Dogs

Background: There is no gold standard to evaluate postoperative pain in animals. The study was conducted to evaluate haematobiochemical changes following intraperitoneal bupivacaine and bupivacaine-dexmedetomidine in dogs. Methods: Eighteen clinical cases of dogs requiring laparotomy were randomly divided into three groups viz. Group-B, BD and N comprising of six dogs in each. The animals were premedicated with glycopyrrolate, meloxicam and diazepam. Anaesthetic induction and maintenance was done by using propofol. Intraperitoneally bupivacaine, bupivacaine-dexmedetomidine and normal saline were infused in the three groups. The blood samples were collected prior to pre-medication at 0 min (base line), 30 min (after induction), 2 hrs and 24 hrs interval after intraperitoneal administration of drugs for estimation of haematobiochemical parameters. Result: The bupivacaine and dexmedetomidine combination reduces the serum glucose and cortisol level which might be indicative of lowered pain response.

Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial

BackgroundWe evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy. MethodsNinety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg−1 bupivacaine 0.5% combined with either 1 μg.kg−1 of dexmedetomidine (Group D), 30 mg.kg−1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively. ResultsFLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026). ConclusionDexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.

Pain after Laparoscopic Cholecystectomy: Effect of IntraperitonealInfiltration of Injection Bupivacaine

Objective: The aim of this study is to determine the effectiveness of intraperitoneal bupivacaine in patients undergoing laparoscopic cholecystectomy. Study Design: Prospective randomized study Place and Duration: Study was conducted at the department of SurgeryDow University Hospital (Ojha), Karachi for duration of six months from May 2021 to October 2021. Methods: There were 70 patients of both genders were presented in this study. Adult patients above 16 years of age, ASA class 1 & 2, undergoing elective cholecystectomy were included in this study. Informed written consent was taken from all the patients for detailed demographics age, sex and body mass index. Patients were categorized into 2 groups. Group A had 36 patients and received 40 ml of intraperitoneal infiltration 0.25% Bupivacaine at Gall Bladder bed and Right Subphrenic space. Group B control group with 34 patients received no intraperitoneal Bupivacaine. Both groups received 20 ml of 0.25% Bupivacaine at ports site incisions. All patients were educated about the standard Visual Analogue Score (VAS) pain score of 0 – 10, during pre anaesthetic evaluation visit. SPSS 23.0 version was used to analyze data. Results: There were 28 (77.8%) females in group A and in group B females were 31 (91.2%). 43.55±13.93 years were the mean age in group A and in group B mean age was 39.94±11.54 years. Mean body mass index of group A was 26.14±13.41 kg/m2 and in group II mean BMI was 25.06±11.53 kg/m2. In group B close technique was used in 26 (72.2%) while in group B 24(70.6%) cases received closed technique. Post-operatively low pain score was observed in study group as compared to group B. Frequency of rescue analgesic was higher in group B as compared to group A. Conclusion: We concluded in this study that the use of intraperitoneal bupivacaine for laparoscopic cholecystectomy was significantly effective in terms of low pain and is an effective method for improving the quality of life within the early recovery period.

Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study

Background & objetives: Laparoscopic procedures are usually followed by postoperative pain of variable intensity. The pain occurs due to streching of the visceral organs and peritoneum. We compared the antinociceptive effect of intraperitoneal instillation of bupivacaine with a combination of bupivacaine and dexmedetomidine in laparoscopic surgery. We assessed the quality of analgesia, time to the first request of rescue analgesia and total analgesics required in the first 24 h.
 Methodology: After institutional ethical committee approval a total of 162 patients were selected, out of which 81 patients were allocated into two groups using table of randomization. Group B received 0.25 % bupivacaine 50 ml with 5 ml normal saline and Group BD received 0.25 % bupivacaine 50 ml plus dexmedetomidine 1 µg/kg diluted in 5 ml of normal saline intraperitoneally.
 Results: We found a significant difference between mean VAS scores of the two groups in all time points (p < 0.05). There was significant difference between mean time to the first request for analgesia and the mean total dose for analgesic required (p < 0.05) in between both groups.
 Conclusion: We conclude that intraperitoneal instillation of dexmedetomidine 1 µg kg in combination with bupivacaine 0.25% in elective laparoscopic cholecystectomy significantly reduces the postoperative pain and analgesic requirement in postoperative period when compared to bupivacaine 0.25% alone.
 Abbreviations: VAS – Visual analog scale; NS - Normal saline; PACU - post‑anesthesia care unit; HR – Heart rate;
 Key words: Anesthetics, Local / administration & dosage; Bupivacaine / administration & dosage; Cholecystectomy, Laparoscopic / adverse effects; Dexmedetomidine, Intraperitoneal; Bupivacaine; Visual analogue scale; Pain Measurement; Pain, Postoperative / diagnosis; Pain, Postoperative / etiology; Pain, Postoperative / prevention & control
 Citation: Shankar S, Gupta BK, Singh MK, Pandey AR, Dwivedi V, Sachan S. Intraperitoneal bupivacaine alone or with dexmedetomidine for post-operative analgesia following laparoscopic cholecystectomy: A prospective randomized comparative study. Anaesth. pain intensive care 2022;26(3):347-351. DOI: 10.35975/apic.v26i3.1909
 Received: August 09, 2021; Reviewed: November 19, 2021; Accepted: December 09, 2021

EFFECTS OF INTRAPERITONEAL BUPIVACAINE VERSUS PLACEBO ON POSTOPERATIVE PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMISED DOUBLE BLIND STUDY

Background & Aims: Postoperative abdominal and visceral pain after elective Laparoscopic Cholecystectomy (LC) is of prime concern to patients as it causes signicant distress. (1)(2) The aim of our study was to evaluate the benet of intraperitoneal bupivacaine irrigation on the surgical bed versus placebo. Methods: 50 patients undergoing elective laparoscopic cholecystectomy were included in the study. They were prospectively randomised into 2 groups. The placebo group (Group P, n = 25) received 35 cc saline without bupivacaine, installed into the gallbladder bed. The bupivacaine group (Group B, n =25) were given 35 cc of 0.25% bupivacaine at the same location. Pain was evaluated at regular intervals of 0, 5, 10, and 24 hours using the visual analogue scale (VAS). Result: Asignicant difference (P=) was seen on VAS to evaluate post-operative pain between two groups at 5 hours post operatively. Conclusion: Irrigation of local anaesthetic bupivacaine at the gall bladder bed can be an effective method for decreasing post-operative pain in the rst 5 hours after laparoscopic surgery.

Efficacy of intraperitoneal bupivacaine in laparoscopic bariatric surgery

A best evidence topic has been constructed using a described protocol. The three-part question addressed was: In [patients undergoing bariatric surgery], is [intraperitoneal local bupivacaine during the operation ] associated with [ lower pain score and decrease in post operative pain medications]?The search has been done and six randomized trial studies are considered to be appropriate to answer this question. The outcome assessed is the value of intraperitoneal bupivacaine in bariatric surgery in terms of effect on the pain score and post operative analgesia. We concluded that intraperitoneal bupivacaine causes improvement in both the pain score and post operative analgesia.

Intraperitoneal Bupivacaine versus Nalbuphine in Postoperative Pain Relief after Laparoscopic Cholecystectomy: A Randomised Clinical Study

Introduction: The rationale for using an intraperitoneal route for instilling a drug, local anaesthetic or opioid is that the exposure of peritoneum to visceral nociceptive conduction provides additional mechanism of analgesia. Aim: To compare the effectiveness of intraperitoneal bupivacaine and nalbuphine for postoperative pain relief after laparoscopic cholecystectomy. Materials and Methods: The present study was a randomised clinical study in which 80 patients underwent laparoscopic cholecystectomy, received either bupivacaine or nalbuphine intraperitoneally. Each patient was monitored postoperatively, as per the institution protocol. Severity of pain was assessed using the Visual Analog Scale (VAS) at rest and at movement Immediately After Recovery (IAR), after one hour and every four hours thereafter. The time to first rescue analgesic was compared. The data analysis was carried out with unpaired Student’s t-test and Chi-square test using software Statistical Package for the Social Sciences (SPSS) 20.0 version. Results: The study included 35 males and 45 females, with a mean age of 42.8±7.1 years. Both groups were well-matched demographically. There was no significant difference in the Heart Rate (HR) or Mean Arterial Pressure (MAP) between the groups postoperatively. However, VAS score was significantly lower in nalbuphine group at one hour (2.52±0.640) as compared to bupivacaine group (2.88±0.791, p=0.028), but on movement at 16 hours it was lower in bupivacaine group (1.43±0.501), as compared to Nalbuphine group (1.67±0.474, p=0.030). The mean time of first rescue analgesic in nalbuphine group was 20.25±7.983 minutes, while in bupivacaine group it was 26.9±6.95 minutes (p-value-0.0002). Postoperative Nausea and Vomiting (PONV) was significantly higher with nalbuphine (35% vs 12.5%). No other significant complication was noted in either group. Conclusion: Intraperitoneal instillation of nalbuphine is an effective and safe way to reduce postoperative pain in patients undergoing laparoscopic cholecystectomy

Comparison of Intraperitoneal Bupivacaine and Intravenous Ketorolac for Postoperative Pain Management Following Laparoscopic Cholecystectomy.

BackgroundPostoperative pain following laparoscopic cholecystectomy (LC) arises from incision sites and residual intraperitoneal CO2 gas. Opioids as a class of pain-relieving drugs are broadly used to control pain after LC; however, these drugs can cause various side effects.ObjectivesThe purpose of this study was to compare the efficacy of intraperitoneal injection of bupivacaine with that of intravenous ketorolac in managing postoperative pain in patients who had undergone LC.MethodsThis randomized, double-blind clinical trial was carried out on patients who had undergone LC. Ninety patients who had undergone elective LC were randomly divided into 3 groups (n = 30 for each group). Group A received 40 mL of 0.25% bupivacaine solution intraperitoneally at the end of the operation; group B received 30 mg of ketorolac intravenously 30 minutes before surgery and every 8 hours after surgery, and patients in group C received normal saline intraperitoneally and intravenous injection. The patients were postoperatively assessed for Visual Analog Scale (VAS) scores, postoperative opioid consumption, shoulder pain, side effects (sedation, nausea, and vomiting), and satisfaction. The data were analyzed using SPSS. P values < 0.05 were considered significant.ResultsThe intraperitoneal injection of bupivacaine and intravenous injection of ketorolac were significantly effective in reducing postoperative abdominal pain, shoulder pain, and incidence of nausea and vomiting compared to the placebo group (P < 0.001). Although intraperitoneal bupivacaine and intravenous ketorolac had no significant difference in pain relief compared with each other, patients in both bupivacaine and ketorolac groups were significantly more satisfied with their analgesia compared to the control group (P < 0.001).ConclusionsIntraperitoneal injection of bupivacaine and intravenous injection of ketorolac both are safe and effective methods to control pain, nausea, and vomiting after LC.

A COMPARISON BETWEEN INSTILLATION OF INTRAPERITIONEAL BUPIVACAINE &amp; MORPHINE vs. BUPIVACAINE ALONE IN ANALGESIA AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Abstract Background Pain after laparoscopic cholecystectomy remains a challenging issue to this relatively less invasive surgery, In this study we try to tackle this problem through intraperitoneal injection of drugs particularly morphine and bupivicaine to reduce post-operative pain. Objectives The Aim of this study is to assess postoperative pain in laparoscopic cholecystectomy by comparing between administering intraperitoneal bupivacaine alone versus intraperitoneal bupivacaine with intravenous morphine; Using the VAS scale and measuring time for rescue analgesic administration. Methods and material This prospective double blinded randomized clinical trial study was conducted in Ain Shams University hospital after approval of the anesthesia department and the local ethics and research committee over 6 months and after obtaining a written informed consent. Sixty patients underwent laparoscopic cholecystectomy were included in the study their ages range between 18 and 60 years old and classified as ASA I and II. The patients were randomly divided using computer generated randomization into two groups 30 patients in each (n = 30), Group BM received 30 ml of mixture of bupivacaine and 2 mg morphine while group BO received bupivacaine only Results This study showed that Morphine bupivacaine admixture had made dramatic decline in shoulder and abdominal pain VAS scores specifically at the 18th and24th hour; 15 patients in the BM group had either VAS score zero or 1 when compared to BO group whom their scores at the 18th and 24th hour was between 4 and 8. Also, there was more decrease in postoperative analgesic consumption in BM group. Conclusions We conclude that intraperitoneal instillation of 2 mg to bupivacaine 0.5% in elective LC significantly reduced post-operative shoulder pain and analgesic requirement when compared to bupivacaine 0.5% alone.

A Systematic Review and Meta-Analysis of Intraperitoneal Bupivacaine in Laparoscopic Gynecologic Surgery.

ObjectiveWe set out to evaluate whether the instillation of bupivacaine versus a saline solution into the peritoneal cavity at time of laparoscopic gynecologic surgery will reduce postoperative pain and postoperative opioid consumption.Data SourcesWe searched six databases: Web of Science, SCOPUS, Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE and PubMed. Our search strategy had no restriction on time or languages and included all studies that met our search algorithm up to March of 2021.Methods of Study SelectionWe included only randomized trials that met our search strategy for the outcomes of 1) pain intensity 24 hours after surgery, 2) pain intensity 6 hours after surgery, and 3) length of hospital stay.Tabulation, Integration, and ResultsWe analyzed continuous data using mean difference (MD) with relative 95% confidence interval (CI). We included 8 randomized clinical trials. We found that intraperitoneal bupivacaine showed significant difference from the saline group regarding pain intensity 24 hours after surgery (MD= −0.73 [−1.10, −0.36]) (P = 0.01) and pain intensity 6 hours after surgery (MD= −1.12 [−2.22, −0.02]) (P = 0.05). Overall, patients allocated to the placebo group seemed to need other analgesics earlier than patients allocated to the bupivacaine group (MD=145.08 [51.37, 238.79] (P = 0.02)). There was no significant difference regarding the length of hospital stay (MD= −0.44 [−1.44, 0.56]) (P = 0.39).ConclusionBupivacaine significantly reduced the visual analog pain score for pain compared with that of the placebo at 6 and 24 hours postoperatively. There was no significant difference in hospital stay.Prospero RegistrationCRD42021254268.

A Comparative Study on the Postoperative Analgesic Effects of the Intraperitoneal Instillation of Bupivacaine Versus Normal Saline Following Laparoscopic Cholecystectomy.

BackgroundLaparoscopic cholecystectomy is widely performed, and postoperative pain is an important factor in patient morbidity during recovery. Various modalities for postoperative pain relief have been proposed, with varying levels of success such as intravenous or intramuscular non-steroidal anti-inflammatory drugs (NSAIDs) and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, regional anesthesia techniques such as epidurals and nerve blocks. The study was aimed to evaluate the efficacy of intraperitoneal instillation of bupivacaine and normal saline on postoperative analgesia, postoperative nausea, and vomiting after laparoscopic cholecystectomy.MethodsThis prospective, controlled, and randomized study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients, aged 18-50 years, who were scheduled for laparoscopic cholecystectomy under general anesthesia. The patients were classified randomly into two groups with an equal number of participants: Group B received intraperitoneal instillation of 30 ml of plain bupivacaine 0.5% and Group N received 30 ml of normal saline. Postoperative pain was recorded using the visual analog scale (VAS) for 24 hours after surgery. Postoperative shoulder pain, nausea, vomiting, and the time taken to request rescue analgesia were noted.ResultsPatients receiving intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first six hours postoperatively (P = 0.04); moreover, the time taken to request rescue analgesia requirement was prolonged (P = 0.04). Side effects, such as nausea and vomiting, were similar between the two groups (P = 0.1 and p = 0.09, respectively) while shoulder pain was significantly lower in the bupivacaine group (P = 0.04).ConclusionBupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia. It also reduces the incidence of shoulder pain but does not decrease postoperative nausea and vomiting.

Effects of intraperitoneal bupivacaine injection in laparoscopic appendectomy in children on post-operative pain: A controlled randomized double-blinded study.

The aim of this study is to determine the effects of local anesthetics administered intraperitoneally in laparoscopic appendectomy. Patients who underwent laparoscopic appendectomy due to acute appendicitis were enrolled in the study. The children were divided into two groups. Intraperitoneal bupivacaine injection to appendectomy site and subdiaphragmatic area was performed after resection of appendix and aspirastion of intraperitoneal reactive fluid in Group 1 while Group 2 did not receive this therapy. The children were questioned by a nurse at postoperative 1st, 6th, 12th, and 24th h. Pain scores (PS) (abdominal), abdominal wall incisional pain (IP), shoulder pain (SP), and first need for analgesics were recorded. One hundred and twenty children were enrolled to the study. There was no significant difference in PS values and IP values between the two groups (p>0.05). SP values at 12th and 24th h were significantly lower in Group 1 (p<0.05). There was a statistically significant reduce in analgesic need in Group 1 (p=0.007). Intraperitoneal bupivacaine instillation to surgery site and subdiaphragmatic area seems to reduce the SP post-opera-tive and also reduce post-operative analgesic need. More meaningful results can be obtained with an increase in the number of patients.

Role of intraperitoneal instillation of bupivacaine after laparoscopic cholecystectomy for post-operative pain management: a randomized controlled trial

Background: Intra peritoneal (IP) local anaesthesia (LA) is a simple, cheap and safest method of providing post-operative (post-op) analgesia after laparoscopic cholecystectomy (LC). In this research, the role of intraperitoneal (IP) instillation of bupivacaine on post-op pain was studied. Post-op pain at 6, 12 and 24 hours was assessed using numeric rating scale. The degree of ambulation postoperatively at 6 and 24 hours and the requirement of analgesics was taken into account. The length of hospital stay was also a factor.Methods: A total of 76 patients during January 2018 to December 2018, undergoing LC, fitting the inclusion criteria were included randomly and divided in to two groups, bupivacaine group (B) and control group (A) based on a pre-generated random number sequence by the principal investigator. The surgical outcome was compared based on multiple parameters and the primary outcome measures were the post-op pain and analgesic requirement.Results: Degree of ambulation at 6 hours was significantly better in group B, compared to group A (p=0.008). The requirement of first dose of rescue analgesia was found to be within 6 hours (post-op) in 34 patients of group A (89.47%) as compared to 13 patients of group B (34.21%), was found to be statistically significant (p&lt;0.001). There was statistically significant (p=0.002) difference with respect to length of hospital stay between the two groups.Conclusions: In our study we found that IP bupivacaine (0.5%) is an effective, economical, safe method of post-op pain management with better post-op recovery.

Preoperative dexamethasone and intraperitoneal bupivacaine for postoperative pain relief

Introduction: Remarkable advancement in managing post-operative pain is made using various analgesics. Dexamethasone is a potent anti-inflammatory, analgesic, and anti-emetic agent and readily available, easy to administer, and a safe adjunct for postoperative analgesia. The intraperitoneal use of local anesthetics is known to improve postoperative pain. The present study is aimed to assess the effectiveness of preoperative dexamethasone combined with intra-peritoneal bupivacaine for postoperative pain relief. Objective: To assess the effectiveness of preoperative Dexamethasone combined with intra-peritoneal Bupivacaine for postoperative pain relief following surgery. Material and Methods: A prospective, randomized controlled study was done over a period of one year on 172 women scheduled for elective gynecological surgeries. The study group received Dexamethasone 8mg IV, 5 minutes prior to induction of anesthesia or before surgical incision, and intra-operatively 30ml of 0.25% Bupivacaine intraperitoneally under aseptic precautions. The control group received standard anesthesia as per the routine hospital protocol. Postoperatively patients monitored for vitals, pain assessment using Visual Analogue Score. The severity of postoperative nausea and vomiting (PONV) was evaluated. After a 24-hour assessment period, patients were asked to make an overall rating of satisfaction with post-operative pain relief on a verbal response (VReS). Results: It was noted that the mean consumption of analgesic doses was significantly high in group B compared to group A (3.01±0.52 vs 1.46±0.83; p<0.001).The mean VRes scores in group A were significantly high compared to group B (2.95±1.01 vs 0.20±0.51; p<0.001). Conclusion: Dexamethasone combined with intra-peritoneal Bupivacaine is highly effective in reducing postoperative pain along with PONV.

High-Volume, Low-Concentration Intraperitoneal Bupivacaine Study in Emergency Laparoscopic Cholecystectomy: A Double-Blinded, Prospective Randomized Clinical Trial.

Background. Laparoscopic cholecystectomy (LC) often results in postoperative pain, especially in the abdomen. Intraperitoneal local anesthesia (IPLA) reduces pain after LC. Acute cholecystitis-associated inflammation, increased gallbladder wall thickness, dissection difficulties, and a longer operative time are several reasons for assuming a benefit in pain scores in urgent LC with IPLA application. The aim was to determine the postoperative analgesic efficacy of high-volume, low-dose intraperitoneal bupivacaine in urgent LC. Materials and Methods. Fifty-seven patients who were American Society of Anesthesiologists physical status I or II were randomly assigned to receive either normal saline (control group) or intraperitoneal bupivacaine (test group) at the beginning or end of urgent LC. The primary outcome was the postoperative pain score of the Visual Analogue Scale (VAS). The secondary outcomes included Visual Rating Prince Henry Scale (VRS), patient satisfaction, and analgesic consumption. Results. Postoperative VAS scores at the first and fourth hours were significantly lower in the test group than in the control group (P < .001). Postoperative VRS scores at the first, fourth, and eighth hours were significantly lower in the test group than in the control group (P < .001, P = .002, P = .004, respectively). Analgesic use was significantly higher in the control group at the first postoperative hour (P < .001). Shoulder pain was significantly lower, and patient satisfaction was significantly higher in the test group relative to the control group (both P < .001). Conclusion. High-volume, low-concentration intraperitoneal bupivacaine resulted in better postoperative pain control and reduced incidence of shoulder pain and analgesic consumption in urgent LC.

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial.

ObjectiveTo compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.MethodsA prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.ResultsThe overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.ConclusionThe combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.Trial RegistrationClinicalTrials.gov Identifier: NCT01039441

Role of intraperitoneal bupivacaine in laparoscopic cholecystectomy

Objective: To compare the mean pain score through Visual Analogue Scale in patients undergoing laparoscopic cholecystectomy with and without intraperitoneal bupivacaine. Study design: Randomized controlled trial.Place and duration of study: General surgery department, Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi from March 2017 till June 2017 for a period of three months.Methodology: Total ninty eight patients were selected for the study. Patients were admitted through OPD. Two were exempted from the study. Both groups had 49 patients. Group A patients received 20 ml of 0.5% of intraperitoneal bupivacaine while Group B patients did not receive intraperitoneal bupivacaine. The anesthetic technique was standardized for the two groups. The degree of postoperative pain was assessed using Visual Analogue Scale at 4,8,12 and 24 hours after the surgery. The results were analyzed on SPSS version 18.Results: The mean pain scores were lower in group A than in group B at rest. Consumption of analgesics was also lower in patients of group A(28%) while it was 71% in patients of group B. The incidence of abdominal pain was significantly lower in patients receiving intraperitoneal bupivacaine.Mean VAS pain scores from 4-24 hrs postoperatively of group A was 0.90± 0.51 with 95% confidence interval while in group B it was 0.96±0.90 with 95% confidence interval.Conclusion: Instillation of 20 ml of 0.5%of intraperitoneal bupivacaine after removal of gall bladder in laparoscopic cholecystectomy offers good analgesia.

Comparative study between intraperitoneal bupivacaine and bupivacaine-nalbuphine for postoperative pain relief after laparoscopic cholecystectomy

Background Postoperative pain relief following laparoscopic cholecystectomy (LC) has been achieved using intraperitoneal (i.p.) local anesthetics. Addition of opioids can prolong postoperative analgesia. Nalbuphine is an agonist–antagonist opioid that provides analgesia without the undesirable effects of pure agonists. This study was performed to compare between postoperative analgesia of i.p. bupivacaine and bupivacaine combined with nalbuphine in patients undergoing LC. Patients and methods This study included 90 patients undergoing LC. They were randomly divided into three groups, with 30 patients each. Postoperatively, group C received 50-ml normal saline (NS), group B0 received bupivacaine 100 mg diluted with NS to 50 ml, and group BN received bupivacaine 100 mg with nalbuphine 10 mg diluted with NS to 50 ml. Pain was assessed using the visual analog scale (VAS) for 24 h, and the first analgesic request was recorded. Total analgesic consumption in 24 h, hemodynamic parameters, and adverse effects were also noted. Results Postoperative VAS values were significantly lower in group BN up to 24 h. Moreover, i.p. bupivacaine showed lower VAS values than in control group. The duration of analgesia was 11.5±0.9, 7.5±0.9, and 1.5±0.6 h in groups BN, B0, and C, respectively (P Conclusion Addition of i.p. nalbuphine to bupivacaine provides superior analgesia than bupivacaine only after LC without an increase in adverse events.

Intraperitoneal Bupivacaine as Post-laparoscopic Cholecystectomy Analgesia.

To assess the efficacy of large volumes of diluted intraperitoneal bupivacaine in post-laparoscopic cholecystectomy analgesia. A randomised controlled trial. Department of General Surgery, Nishtar Hospital, Multan, from August 2018 to June, 2019. Two equal groups with 55 patients each were formed. Normal saline 500 ml in group A, and mixture of 20 ml 0.5% bupivacaine in 480 ml normal saline in group B, was used to irrigate peritoneal cavity. Final outcome of the study was the comparison of pain-free duration. Postoperatively, numerical rating scale (NRS) score at various intervals and total analgesics requirement within 24 hours after the procedure were included in the secondary outcomes. Student's t-test was applied on continuous data and Pearson's Chi-square test on nominal variables. P >0.05 was considered of no statistical significance. Both groups were comparable for age, weight, gender, duration of surgery. Postoperative analgesia duration was 0.99 ± 0.51 hours in group A and 16.53 ±2.65 hours in group-B (p<0.001). On average, 124.80 ±26.68 mg and 31.00 ±14.98 mg tramadol was given to group A and B patients, respectively (p<0.001). There was statistically significant difference in NRS score at 30 minutes, 1, 3, 6 and 12 hours postoperatively (p<0.05). NRS score at ETT extubation and at 24 hours was statistically not different (p >0.05). Large volume of diluted bupivacaine when injected intraperitoneally during laparoscopic cholecystectomy provides prolonged time pain relief.