Intraperitoneal Instillation Of Bupivacaine Research Articles

Ultrasound-Guided Transversus Abdominis Plane Block Versus Intraperitoneal Instillation of Bupivacaine after Laparoscopic Cholecystectomy – A Randomized Control Trial

Background: Postoperative pain prolongs hospital stay after laparoscopic cholecystectomy and remains a major challenge during the postoperative period. Effective pain control encourages early ambulation, which significantly reduces postoperative complications. In recent years, multimodal analgesia has been recommended with fewer adverse effects and more effective analgesia. The primary objective of this study was to compare the efficacy of analgesia between Transversus Abdominis Plane Block (TAP) Block and intraperitoneal instillation of bupivacaine by comparing the meantime of the first dose of rescue analgesia in either group and the total supplementary analgesia required. Methods: This retrospective observational study was conducted on 150 patients who underwent laparoscopic cholecystectomy Group 1 comprised of patients who had received Intraperitoneal Bupivacaine for analgesia and Group 2 received TAP Block for pain relief. Results: Time of the first dose of analgesia after surgery was observed earlier in Group 1 as compared to Group 2 (Time – hours: 9.2 ± 2 vs. 12.3 ± 1.6; p = 0.0001. The Total dose of analgesic was higher in the Intra Peritoneal Bupivacaine Group as compared to the TAP group. Conclusion: AP block provided for a better quality of analgesia as assessed by the reduced requirement of intravenous supplementary analgesia which was less in patients who were given TAP Block as compared to local instillation of Bupivacaine. Keywords: Cholecystectomy, Bupivacaine, Transversus abdominis plane block

Assesment of Postoperative Analgesic Effects of Intramuscular Tramadol Administration and Intraperitoneal Bupivacaine following Laparoscopic Cholecystectomy

Background: For postoperative pain relief after laparoscopic surgeries, intramuscular or intravenous non-steroidal anti-inflammatory drugs and opioids, infiltration at the incision site with local anesthetics, intraperitoneal infiltration of local anesthetics with adjuvants, epidurals and nerve blocks were in use. The study was aimed to assess the efficacy of intramuscular Tramadol and intraperitoneal instillation of bupivacaine on postoperative analgesia, postoperative nausea, and vomiting following laparoscopic cholecystectomy.
 Methods: This study included 60 American Society of Anesthesiologists (ASA) I and ASA II patients of aged 18-60 years who were scheduled for laparoscopic cholecystectomy under general anesthesia. 60 patients were classified randomly into two groups equally: Group T received 100 Mg of intramuscular tramadol and Group B received intraperitoneal instillation of 30 ml of plain bupivacaine. Time duration, postoperative pain, haemodynamics, nausea, vomiting, and time taken to rescue analgesia were noted.
 Results: The time for onset of analgesia was 6.51 ± 2.41min in group T and 7.61 ± 2.19 min in group B (p=0.039). The duration of analgesia was 2.37 ± 0.67 hours in group T and 3.65 ± 0.79 hours in group B (p=0.002). VAS Score was significantly lower in Group T than Group B at 1hr, 2hr, 4hr and 6hr (p <0.05). Intraperitoneal bupivacaine showed a significant reduction in postoperative pain for the first 6 hours postoperatively (P<0.05), and time taken to rescue analgesia requirement was prolonged (P<0.05). The rescue analgesia consumption of Paracetamol was 1.5 grams in group-B and 2.5 grams in group T (P<0.05) in 24 hr post-surgery. Nausea and vomiting were observed in 2 cases, and shoulder pain in one case in group T.
 Conclusion: Bupivacaine is effective in reducing postoperative pain, and it prolongs the requirement time for rescue analgesia after LC surgery. It also required less consumption of rescue analgesic without fluctuations in hemodynamics

COMPARATIVE STUDY TO ASSES ANALGESIC EFFICACY AND OPIOID SPARING EFFECT OF USG GUIDED SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN PATIENT UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY FOR POSTOPERATIVE PAIN RELIEF.

Background- Intensity of pain in early post-operative period after laparoscopic cholecystectomy is signicant. There are several methods employed in the management of postoperative pain after laparoscopic cholecystectomy such as conventional systemic analgesics, including paracetamol, non-steroidal anti-inammatory drugs, systemic opioids, and thoracic epidural analgesia with all having its limitations and side effects. Objective- The present study aims to compare ultrasound-guided subcostal transversus abdominis (STA) block with intraperitoneal instillation of bupivacaine in reducing postoperative pain, total analgesic consumptions after elective laparoscopic cholecystectomy. Materials and methods: 60 adult patients were randomly divided into 2 groups of 30 in each. The selected patients were randomly divided into two groups Group 1, patients received USG guided tap block before surgery. Group 2 patients received 40 ml of 0.25 % bupivacaine after surgery, instillation done by surgeon intraperitoneally at gall blabber bed and under the domes of diaphragm. Statistical analysis: In all Quantitative data were expressed in mean and standard deviation. Qualitative data were expressed in proportion and percentages. To nd the signicant difference between the bivariate samples in independent groups the Unpaired sample t-test and the Mann-Whitney U test was used. Above statistical tools the probability value > .05 was considered as signicant level. Results: The mean Numerical Rating Scale scores were less in Group 1 than in Group 2 from 1 hours to 24 hours and it was statistically signicant. Demand of rescue analgesia was higher in group 2 when compared to group 1 and it was statistically signicant. Conclusion: TAP block is a better modality for analgesia compared to intraperitoneal instillation in patients undergoing elective laparoscopic cholecystectomy

A COMPARATIVE STUDY OF EFFECTIVENESS OF INTRAPERITONEAL INSTILLATION OF BUPIVACAINE IN LAPAROSCOPIC CHOLECYSTECTOMY WITH AND WITHOUT ITS INSTILLATION IN POST-OPERATIVE PAIN MANAGEMENT

Introduction: Laparoscopic cholecystectomy is a gold standard surgical procedure in post-operative pain recovery time. Though it is associated with lesser post-op pain than open cholecystectomy, few patients still experience pain. Pain relief is an important goal of any surgery. Administration of local anaesthetic either during surgery is a method of reducing post-op pain. To Compare the effect of intraperitoneal Aim: instillation of 0.5% bupivacaine with adrenaline and without intraperitoneal instillation of 0.5% bupivacaine with adrenaline for post-operative analgesia in laparoscopic cholecystectomy. A total of 120 participants we Materials & Methods: re considered for this study with 60 participant receiving bupivacaine and other 60 receiving normal saline. VAS/VRS score is measured at 2, 4, 6, 12 & 24 hours after surgery for each group. Results: From the results, we found signicant differences in the mean scores of study group and placebo group. The patients who were given bupivacaine were found to have reduced pain. Conclusion: In our study, we found that bupivacaine reduces postoperative pain. We conclude that the intraperitoneal instillation of bupivacaine is a safe and effective method for providing postoperative analgesia without signicant side effects.

Comparison of administration of intraperitoneal bupivacaine and intraperitoneal bupivacaine with dexmedetomidine in post laparoscopic cholecystectomy patients for post operative pain relief

Introduction: Intraperitoneal administration of local anesthetic found to be effective in controlling postoperative pain in laparoscopic surgeries. So, this prospective study was conducted to compare antinociceptive effect of intraperitoneal administration of bupivacaine and bupivacaine with dexmedetomidine in patients after undergoing Laparoscopic Cholecystectomy. Materials and Methods: A total of 60 patients of either sex undergoing laparoscopic cholecystectomy were randomly divided into two groups 30 patients in each. Group B received intraperitoneal 50ml bupivacaine 0.25 % (125mg). Group BD received intraperitoneal 50ml bupivacaine 0.25 % (125mg) and 50µg dexmedetomidine before removal of trocar at end of the surgery. Post op analgesia (VAS Score), sedation, Vitals was assessed at different time intervals. Time to first rescue analgesia, total dose of analgesic and adverse effect were noted. Results: We observed significant difference in mean VAS score at 8hr, 12hr, 16hr and 20hr between two group with 2.27+0.74, 3.03+0.67, 3.5+0.63, 4.03+0.72 in group B and 1.7+1.36, 2.1+1.09, 2.6+1.22, 3.03+1.09 in group BD respectively. The mean time to first rescue analgesia in group B was 8.86+ 4.13hrs and 11.64+ 3.95hrs in group BD. Total analgesic consumption was less in Group BD. Conclusion: Intraperitoneal instillation of bupivacaine with dexmedetomedine is superior to bupivacaine alone in terms of duration of post operative analgesia, total analgesic consumption in the post laparoscopic cholecystectomy patients. Keywords: Laproscopic cholecystectomy, Intraperitoneal instillation, Bupivacaine, Dexmeditomidine.

Port Site Infiltration and Intraperitoneal Instillation of Bupivacaine for Post Operative Analgesia in Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has become the gold standard treatment method for symptomatic gallstone diseases. However pain is the only complaint that delays the discharge. This study aimed to evaluate the efficacy of bupivacaine infiltration into port site and instillation into peritoneal cavity to reduce pain following laparoscopic cholecystectomy. One hundred patients underwent elective laparoscopic cholecystectomy enrolled in this study. Patients were divided into experimental group (Group A) and control group (Group B) of 50 patients each. Following removal of gallbladder, patients of experimental group received 20 ml of 0.5% bupivacaine in gallbladder bed and 20 ml of 0.5% bupivacaine was infiltrated into 4 port sites. Control group received no treatment. The evaluation of postoperative pain was done at 4, 8, 12 and 24 hours postoperatively by using Visual Analogue Scale and the dose of NSAID was also recorded. Mean VAS score at 4, 8 and 12 hours postoperatively in experimental group was less than that of the control group (p<0.05). VAS score at 24 hours postoperatively did not differ between two study groups (p>0.05). The mean total NSAID doses used during first 24 hours postoperatively was less in the experimental group than control group (p<0.05). The localization of pain during first 24 hours postoperatively was 62% incisional, 29% intra abdominal and shoulder tip pain 9%. Port site infiltration and intraperitoneal instillation of bupivacaine following laparoscopic cholecystectomy reduce pain following laparoscopic cholecystectomy and this simple, inexpensive and effective method should be practiced to minimize early postoperative pain for all elective laparoscopic cholecystectomy.
 Faridpur Med. Coll. J. Jul 2019;14(2): 58-61

Assessment of Effect of Port Site and Intraperitoneal Instillation of Bupivacaine in Reduction of Post-Operative Pain After Laparoscopic Cholecystectomy

Aim: Effective postoperative pain control is an essential component for care of surgical patients. Inadequate pain control may result in increased morbidity or mortality. Analgesic effects of periportal infiltration of local anesthetics, infiltration of periportal parietal peritoneum, intraperitoneal spraying at subdiaphragmatic space and subhepatic space covering the area of hepatoduodenal ligament have been reported. The present controlled study aimed at assessing the effect of port site injection and intraperitoneal instillation of bupivacaine in reduction of post-operative pain after laparoscopic cholecystectomy. Methods: The present study was conducted among a group of 180 patients diagnosed to have symptomatic cholelithiasis and who underwent elective laparoscopic cholecystectomy under general anesthesia. In group 1, pre-incisional local infiltration of 20ml 0.5% bupivacaine at the port sites; and in group 2, local infiltration of 20ml 0.5% bupivacaine at the port sites with intraperitonial installation. In group 3, no local infiltration was done and treated as control group. Pain assessment is based on a Universal Pain Assessment Tool. Analysis of our study was performed one-way ANOVA & Post HOC test (Scheffe's HSD) & Chi square tests as and when indicated. Results: Mean pain scores at 30 minutes were significantly lower in groups 1 & 2 compared to control group; but however, the values were not significantly different when compared to each other. Similarly, the mean pain scores at 4th, 8th, 16th and 24th hours for the preincisional and preclosure groups, didn't signify any inter-group advantage. Therefore, bupivacaine provides a substantial reduction of pain intensity up to 24 hours postoperatively; and was found to be statistically significant. However, timing of anesthesia was found to be statistically insignificant in terms of preclosure vs pre incisional of the port sites. Conclusion: Instillation of bupivacaine at the port sites in laparoscopic cholecystectomy irrespective of the timing of instillation is an effective method of achieving pain control in the post-operative period as long as 24 hours after surgery. There was no statistically significant reduction of post-operative pain between the pre-incisional and pre-closure groups.

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

The Impact of Intraperitoneal Dexmedetomidine with Bupivacaine on Patients’ Postoperative Pain in Endometriosis Laparoscopic Surgery; A Randomized, Clinical Trial

Background: Endometriosis is routinely treated with laparoscopy, which despite significant advantages over laparotomy cannot diminish postoperative pain. Insufficient postoperative pain control decreases patient satisfaction. Objectives: This study was designed to evaluate the efficacy of intraperitoneal dexmedetomidine (DEX) combined with bupivacaine on postoperative pain in endometriosis laparoscopic surgery. Methods: Fifty-three patients with endometriosis, scheduled for laparoscopy in Rasoul-e-Akram Hospital, Tehran, from January 2016 to May 2017 who were randomly divided into three groups, including group 1 (G1, n = 21) received 50 mL intraperitoneal saline, group 2 (G2, n = 16) received 50 mL intraperitoneal instillation of bupivacaine 0.25%, and group 3 (G3, n = 16) received 50 mL bupivacaine 0.25% plus dexmedetomidine 1 µg/kg. Each patient with a history of allergy to local anesthetics or dexmedetomidine, cardiac disease, renal or hepatic failure, severe pulmonary disease; in addition, pregnant and comorbid obese patients were excluded from the study. Patients’ postoperative pain was assessed in the recovery room after 2, 6, 12, 24, and 48 hours using visual analogue scale (VAS). Total analgesic consumption was also recorded. Results: The postoperative VAS scores were significantly lower in group 3 than other groups in the recovery room, and 2, 6, 12, 24 and 48 hours after the surgery (P < 0.001). However, there was no significant difference between 1 and 2 groups. Furthermore, total VAS in the first 24 hours in group 3 was significantly lower than the two other groups (P < 0.001). Conclusions: We conclude 1 μg/kg intraperitoneal DEX administration combined with bupivacaine may prolong postoperative analgesia and decrease rescue analgesia requirement compared with bupivacaine alone.

Comparative evaluation of subcutaneous infiltration (port site) vs intraperitoneal infiltration of bupivacaine on post laparoscopic cholecystectomy pain

Background: Laparoscopic cholecystectomy (LC) is now the gold standard technique for the treatment of gallstones disease. Although pain after LC is less intense than after open cholecystectomy, some patients still experience considerable discomfort during early postoperative hours. The aim of this study is to evaluate the effect of intraperitoneal and port site instillation of local anaesthetics on pain relief in early postoperative period following LC.Methods: This is a randomized, prospective analytical study among patients subjected to elective laparoscopic cholecystectomy. Patients were divided into 3 groups as; Group 1 was control, Group 2 was assigned to receive portside infiltration of bupivacaine, while group 3 received combined port site and intraperitoneal instillation of bupivacaine. The evaluation of postoperative pain was done according to the visual analog scale and the dosage of narcotic analgesics consumed and duration of hospital stay was also recorded.Results: At 1st post-operative hour, minimum VAS score was in group 3 (p=0.003). At 4th post-operative hour, Minimum VAS score was in group 3(p=0.015). At 8th post-operative hour, Minimum VAS score was in group 3, (p=0.044). Patients in group 3 received a lower total amount of rescue analgesia and they also had the shortest hospital stay after LC, compared to the patients in the other groups. As regarding the incidence of right shoulder pain, group 3 has minimal no of patients experienced rt shoulder tip pain.Conclusions: Infiltration of bupivacaine into port site and intraperitoneal space is simple, inexpensive and effective technique to minimize early postoperative pain and can be practiced for elective LC.

Intraperitoneal instillation of bupivacaine in gallbladder fossa and at trocar sites in reduction of postoperative pain after laparoscopic cholecystectomy: a prospective randomized controlled double blind trial

Background: Pain relief remains landmark achievement attributed to laparoscopic cholecystectomy. Post laparoscopic cholecystectomy patient still complains of incisional pain, shoulder pain and vague upper abdominal pain. A simple method of portal or incisional infiltration and intraperitoneal spraying of a local anaesthetic agent over gall bladder fossa can reduce postoperative pain. The mean duration of action of bupivacaine hydrochloride is 8.07 hours which is 2-3 times longer than lignocaine.Methods: This study was conducted to determine whether local infiltration of bupivacaine at trocar sites and gall bladder fossa has any effect in postoperative pain relief. This prospective study was conducted on 60 patients (3 groups) undergoing laparoscopic cholecystectomy. In group A, 20ml of 0.25% bupivacaine was instilled subcutaneously at all trocar sites. In group B, 20ml of 0.25% bupivacaine was instilled in gallbladder fossa after removal of gall bladder. In group C, 20 ml bupivacaine was instilled at the gall bladder fossa and 20% was instilled at the trocar sites as mentioned for group A.Results: Chi square analysis of NRS of pain at 1, 6, 12, 24 hours post operatively shows significant improvement in NRS scores in group A and C compared to group B.Conclusions: Infiltration of 0.25% bupivacaine at all trocar sites with or without infiltration in gall bladder fossa is an effective method of postoperative pain relief when compared to infiltration of gall bladder fossa alone.

Effectiveness of Local Anesthetics in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

Laparoscopic cholecystectomy is the gold standard for gallstone disease. Postoperative pain still is considerable and may prevent early discharge. A randomized controlled blind clinical trial was designed for all patients undergoing laparoscopic cholecystectomy. The groups were control (group A), preincisional trocar wound infiltration with bupivacaine (group B), and preincisional trocar wound infiltration and intraperitoneal instillation of bupivacaine over the gallbladder and liver surface before starting the dissection (group C). The operative technique and postoperative analgesia were standardized. The pain in 6 hours was assessed with the visual analog scale as the primary outcome. The visual analog pain scores in the intraperitoneal bupivacaine were similar to the trocar wound infiltration alone and both were lower than the control group (P=0.05616). Intraperitoneal application of local anesthetics and trocar wound infiltration did not lower the pain scores in comparison with trocar wound infiltration in our study.

Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation.

Background and Aims:Intraperitoneal instillation of local anaesthetics has been shown to minimise post-operative pain after laparoscopic surgeries. We compared the antinociceptive effects of intraperitoneal dexmedetomidine or tramadol combined with bupivacaine to intraperitoneal bupivacaine alone in patients undergoing laparoscopic cholecystectomy.Methods:A total of 120 patients were included in this prospective, double-blind, randomised study. Patients were randomly divided into three equal sized (n = 40) study groups. Patients received intraperitoneal bupivacaine 50 ml 0.25% +5 ml normal saline (NS) in Group B, bupivacaine 50 ml 0.25% + tramadol 1 mg/kg (diluted in 5 ml NS) in Group BT and bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg, (diluted in 5 ml NS) in Group BD before removal of trocar at the end of surgery. The quality of analgesia was assessed by visual analogue scale score (VAS). Time to the first request of analgesia, total dose of analgesic in the first 24 h and adverse effects were noted. Statistical analysis was performed using Microsoft (MS) Office Excel Software with the Student's t-test and Chi-square test (level of significance P = 0.05).Results:VAS at different time intervals, overall VAS in 24 h was significantly lower (1.80 ± 0.36, 3.01 ± 0.48, 4.5 ± 0.92), time to first request of analgesia (min) was longest (128 ± 20, 118 ± 22, 55 ± 18) and total analgesic consumption (mg) was lowest (45 ± 15, 85 ± 35, 175 ± 75) in Group BD than Group BT and Group B.Conclusion:Intraperitoneal instillation of bupivacaine in combination with dexmedetomidine is superior to bupivacaine alone and may be better than bupivacaine with tramadol.

The Postoperative Analgesic Efficacy of Intraperitoneal Bupivacaine Compared with Levobupivacaine in Laparoscopic Cholecystectomy

Background: The aim of this randomized controlled study was to compare the postoperative analgesic efficacy of intraperitoneal bupivacaine versus levobupivacaine in patients undergoing laparoscopic cholecystectomy. Methods: We randomly divided 90 patients undergoing elective laparoscopic cholecystectomy into 3 groups. A dose of 0.125% bupivacaine (Group B) 80 ml or 0.125% levobupivacaine (Group L) 80 ml or 0.09% NaCl (Group P) 80 ml was instilled intraperitoneally at the end of the procedure, before removal of the trocars. All patients had a standard anesthetic. Tramadol was administered intravenously via a patient controlled analgesia pump as a rescue analgesic in all patients. Postoperative pain scores were assessed at 30 minutes, 1, 2, 4, 6,12 and 24 hours after surgery by using a visual analog scale. The primary end point of this study was to compare tramadol consumption of the three groups at the postoperative 24 h. Total tramadol consumption, first analgesic requirement time and adverse effects were recorded. Results: Group B experienced significantly less pain (P < 0.01) than the placebo group at 6 h, 12 h and 24 h postoperatively during rest. Group L registered significantly lower visual analog scale scores (p < 0.01) than the placebo group at 12 h during rest. During movement, visual analog scale pain scores were lower in group B than Group P (P < 0.01). Additionally, total tramadol consumption was significantly lower in Group B than the other groups. First analgesic requirement time was shorter in the placebo group compared with group B and group L (P < 0.05). There was no significant difference between the groups with respect to right shoulder pain, total nausea and vomiting. Conclusion: Intraperitoneal instillation of bupivacaine 0.125% 80 ml (100 mg) is more effective than levobupivacaine 0.125% 80 ml (100 mg) in reducing the postoperative pain after laparoscopic cholecystectomy.

Postoperative Pain After Laparoscopic Cholecystectomy

Pain is the most common complaint of patients on the first day after laparoscopic cholecystectomy (LC). This clinical trial compared the effects of intraperitoneal (IP) bupivacaine and intravenous (IV) pethidine on this pain. Forty-eight patients who underwent LC were randomly assigned to 2 groups of IP bupivacaine and IV pethidine. Postoperative pain, oral analgesic consumption, peak expiratory flow rate, and presence of nausea or vomiting was recorded at baseline and 4, 8, and 24 hours after surgery. Patients who received IP bupivacaine showed a significantly lower pain score (P = 0.022) and improved peak expiratory flow rate (P = 0.006), and received lower doses of ibuprofen (P = 0.003) within the first 24 hours after surgery. Likewise, the presence of nausea/vomiting was significantly lower in bupivacaine groups 1 and 4 hours after surgery (P = 0.003 and 0.005, respectively). Our results indicate that IP instillation of bupivacaine is more beneficial than traditional IV pethidine for pain reduction after LC.

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Background:Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries.Methods:A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM (n=30): 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO (n=30) 30 ml 0.25% bupivacaine and in group C (n=30) 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS (0-100), for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted.Results:Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain (VAS: 23.33±6.04 vs. 45.5±8.57). It also reduces pain at 4 hours after surgery in the BM group (VAS 24±12.13 vs. 41.17±7.27 in the BO group). The time of administration of first rescue analgesic was significantly higher in the BM group (6.15 hours) compared to the BO group (4.51 hours). The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group.Conclusion:Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events.

Intra-Peritoneal Instillation of Bupivacaine for the Reduction of Post-Operative Pain after Laparoscopic Hysterectomy: A Double-Blind Randomized Controlled Trial

Intra-Peritoneal Instillation of Bupivacaine for the Reduction of Post-Operative Pain after Laparoscopic Hysterectomy: A Double-Blind Randomized Controlled Trial

Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study

This study aimed to evaluate the optimal timing of preemptive analgesia with bupivacaine peritoneal instillation in a prospective, randomized, double-blind, placebo-controlled trial. In this study, 120 patients qualified for laparoscopic cholecystectomy were randomized to four groups. Group A received 2 mg/kg of bupivacaine in 200 ml of normal saline before creation of pneumoperitoneum. Group B received 2 mg/kg of bupivacaine in 200 ml of normal saline after creation of pneumoperitoneum. Group C received 200 ml of normal saline before creation of pneumoperitoneum. Group D received 200 ml of normal saline after creation of pneumoperitoneum. Local wound infiltration with bupivacaine was used before skin incisions. The primary end points of the study were postoperative pain intensity on a visual analog scale and incidence of shoulder tip pain. The secondary end points included the latency of nurse-controlled analgesia activation, the analgesia request rate, and analgesic consumption. Significantly lower visual analog scores were observed in group A versus groups C and B versus group D during the initial 48 and 24 h, respectively. The patients in group A versus group B reported significantly lower pain at 4 h (p < 0.001) and 8 h (p = 0.003) postoperatively, but the difference was not significant after 12, 24, and 48 h. None of the group A patients reported shoulder tip pain, whereas it was reported by 3 patients in group B, 6 patients in group C, and 7 patients in group D (p < 0.01). The latency of nurse-controlled analgesia activation was 426.8 +/-57.2 min in group A, as compared with 307 +/- 39.8 min in group B, 109.3 +/- 51 min in group C, and 109 +/- 46.5 min in group D (p < 0.001). A significantly lower analgesia request rate was observed in group A versus C, as compared with group B versus D, throughout the entire study period (p < 0.05). Preemptive analgesia with bupivacaine peritoneal instillation is much more effective for pain relief if used before creation of pneumoperitoneum. Although the effect of bupivacaine peritoneal instillation is also noticeable when used after creation of pneumoperitoneum, it confers significantly lower benefits.