Intraperitoneal Local Anesthetic Research Articles

Evaluation of the Efficacy of Intraperitoneal Instillation of Ropivacaine with Dexmedetomidine Versus Ropivacaine with Ketamine for Post Operative Pain Relief following Laparoscopic Cholecystectomy: A Randomized Controlled Study

Background: Adjuvants are added to intraperitoneal local anesthetics to prolong analgesia however no study compares Dexmedetomiditine with Ketamine as adjuvant to Ropivacaine for laparoscopic cholecystectomy.
 To compare efficacy of intraperitoneal instillation of Ropivacine with Dexmedetomidine versus Ropivacaine with Ketamine for postoperative pain relief following laparoscopic cholecystectomy.
 Methods: Sixty patients ASA I and ASA II undergoing laparoscopic cholecystectomy were randomly allocated in three groups and received Ropivacaine 0.2 % (group R), Ropivacaine 0.2 % alongwith Dexmedetomidine 0.7 micogrms/ kg (group RD) and Ropivacaine with Ketamine 0.5 mg/kg (group RK) to a total volume of 40ml.The primary outcome measured was time to request of rescue analgesia while secondary outcomes were post op numeric rating scale, total dose of rescue analgesia required in 24 hours and haemodynamic parameters in postoperative period.
 Results: The median time to request of rescue analgesia was shortest in R group 55 [42.5-70] minutes followed by RK group 60 [50.50-72.50] and maximum in the group RD the time being 900 [86.25 -1440] minutes while haemodynamics remained stable in all the groups. Similar findings were seen for total demand of analgesia in 24 hours as well as NRS scale both static and dynamic which was measured periodically in the first 24 hours.
 Conclusion: Dexmedetomiditine 0.7 micrograms per kg when used as adjuvant with Ropivacine is effective combination that prolongs duration than Ropivacaine alone or when used with Ketamine 0.5 mg per kg body weight however total dose of rescue analgesia was significantly less in Ketamine group compared to Ropivacine alone and least when Dexmedetomiditine is used as adjuvant.

Efficacy of nonopioid analgesics and regional techniques for perioperative pain management in laparoscopic gynecological surgery: a systematic review and network meta-analysis.

The optimal approach for perioperative pain management in laparoscopic gynecological surgery is unclear due to a lack of comprehensive analysis, which limits the development of evidence-based enhanced recovery after surgery protocols. This study aimed to conduct a systematic review and network meta-analysis to support clinical decision-making for optimal analgesia. This study conducted a systematic literature search in PubMed, Embase, CENTRAL, Web of Science, and CINAHL from inception to 3 December 2021, and updated on 19 August 2022. Randomized controlled trials comparing the perioperative use of nonopioid analgesics and regional techniques in adults undergoing elective laparoscopic gynecological surgery under general anesthesia were included in the analysis, either alone or in combination. The co-analgesic interventions during the perioperative period for the intervention and control groups of each eligible study were also considered. We assessed the risk of bias using the Risk of Bias 2 tool and evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) approach. A Bayesian network meta-analysis was used to estimate the efficacy of the analgesic strategies. The primary outcomes were pain score at rest and cumulative oral morphine milligram equivalents at 24h postoperatively. Overall, 108 studies with 9582 participants and 35 different interventions were included. Compared with inert treatments, combinations of two or more interventions showed better efficacy and longer duration in reducing postoperative pain and opioid consumption within 24h than monotherapies, and showed stepwise enhanced effects with increasing analgesic modes. In combination therapies, regional techniques that included peripheral nerve blocks and intraperitoneal local anesthetics, in combination with nonopioid systemic analgesics, or combining local anesthetics with adjuvant drugs, were found to be more effective. Monotherapies were found to be mostly ineffective. The most effective peripheral nerve blocks were found to be ultrasound-guided transversus abdominis plane block with adjuvant and ultrasound-guided quadratus lumborum block. These results provide robust evidence for the routine use of regional techniques in combination with nonopioid analgesics in perioperative pain management. However, further better quality and larger trials are needed, considering the low confidence levels for certain interventions.

Effect of Intraperitoneal Local Anesthetics in Laparoscopic Bariatric Surgery: A Meta-Analysis of Randomized Controlled Trials.

The effectiveness of intraperitoneal local anesthesia (IPLA) has been confirmed in other fields, but its use in bariatric surgery remains debatable. This study aimed to evaluate the analgesic effect of IPLA in bariatric surgery. PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to February 2022. All randomized controlled trials (RCTs) assessing IPLA's analgesic effect in bariatric surgery were included in this study. Pain-related indicators were the outcome. Ten RCTs with 979 patients were included. Postoperative pain scores were significantly lower in IPLA group. Subgroup analysis demonstrated that IPLA was associated with lower pain scores in 6h and at 24h compared to the control group, without significant differences at 8, 12, and 48h. Meanwhile, IPLA reduced the dose of opioids taken postoperatively. Additionally, there were no differences in adverse events between the two groups. As far as the number of postoperative analgesics used and hospital stays were concerned, our results did not show statistical differences between the two groups. IPLA can reduce postoperative pain safely and effectively, particularly during the early postoperative stage.

Effect of intraperitoneal local anesthesia on enhanced recovery outcomes after bariatric surgery: a randomized controlled pilot study.

Background:Patients with extreme obesity are at high risk for adverse perioperative events, especially when opioid-centric analgesic protocols are used, and perioperative pain management interventions in bariatric surgery could improve safety, outcomes and satisfaction. We aimed to evaluate the impact of intraperitoneal local anesthesia (IPLA) on enhanced recovery after bariatric surgery (ERABS) outcomes.Methods:We conducted a prospective double-blind randomized controlled pilot study in adherence to an a priori peer-reviewed protocol. Patients undergoing laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) with an established ERABS protocol between July 2014 and February 2015 were randomly allocated to receive either IPLA with 0.2% ropivacaine (intervention group) or normal saline (control group). We measured pain scores, analgesic consumption and adverse effects. Functional prehabilitation outcomes, including peak expiratory flow (PEF) and the Six Minute Walk Test (6MWT) and Quality of Recovery Survey-40 (QoR-40) scores, were assessed before surgery, and 1 day and 7 days postoperatively.Results:One hundred patients were randomly allocated to the study groups, of whom 92 completed the study, 46 in each group. There were no statistically significant differences between the 2 groups in baseline characteristics or any primary or secondary outcomes. Pain scores and analgesic consumption were low in both groups. There were no adverse events. Significant declines in PEF and 6MWT and QoR-40 scores were noted on postoperative day 1 in both groups; the values returned to baseline on postoperative day 7 in both groups.Conclusion:Intraperitoneal local anesthesia with ropivacaine did not reduce postoperative pain or analgesic consumption when administered intraoperatively to patients undergoing LRYGB. Standardization of the ERABS protocol benefited patients, with functional prehabilitation outcomes returning to baseline postoperatively. Trial registration: ClinicalTrials.gov no. NCT 02154763

Intraperitoneal local anaesthetic instillation versus no intraperitoneal local anaesthetic instillation for laparoscopic cholecystectomy.

Pain is one of the important reasons for delayed discharge after laparoscopic cholecystectomy. Use of intraperitoneal local anaesthetic for laparoscopic cholecystectomy may be a way of reducing pain. A previous version of this Cochrane Review found very low-certainty evidence on the benefits and harms of the intervention. To assess the benefits and harms of intraperitoneal instillation of local anaesthetic agents in people undergoing laparoscopic cholecystectomy. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and three other databases to 19 January 2021 together with reference checking of studies retrieved. We also searched five online clinical trials registries to identify unpublished or ongoing trials to 10 September 2021. We contacted study authors to identify additional studies. We only considered randomised clinical trials (irrespective of language, blinding, publication status, or relevance of outcome measure) comparing local anaesthetic intraperitoneal instillation versus placebo, no intervention, or inactive control during laparoscopic cholecystectomy, for the review. We excluded non-randomised studies, and studies where the method of allocating participants to a treatment was not strictly random (e.g. date of birth, hospital record number, or alternation). Two review authors collected the data independently. Primary outcomes included all-cause mortality, serious adverse events, and quality of life. Secondary outcomes included length of stay, pain, return to activity and work, and non-serious adverse events. The analysis included both fixed-effect and random-effects models using RevManWeb. We performed subgroup, sensitivity, and meta-regression analyses. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). We assessed risk of bias using predefined domains, graded the certainty of the evidence using GRADE, and presented outcome results in a summary of findings table. Eighty-five completed trials were included, of which 76 trials contributed data to one or more of the outcomes. This included a total of 4957 participants randomised to intraperitoneal local anaesthetic instillation (2803 participants) and control (2154 participants). Most trials only included participants undergoing elective laparoscopic cholecystectomy and those who were at low anaesthetic risk (ASA I and II). The most commonly used local anaesthetic agent was bupivacaine. Methods of instilling the local anaesthetic varied considerably between trials; this included location and timing of application. The control groups received 0.9% normal saline (69 trials), no intervention (six trials), or sterile water (two trials). One trial did not specify the control agent used. None of the trials provided information on follow-up beyond point of discharge from hospital. Only two trials were at low risk of bias. Seven trials received external funding, of these three were assessed to be at risk of conflicts of interest, a further 17 trials declared no funding. We are very uncertain about the effect intraperitoneal local anaesthetic versus control on mortality; zero mortalities in either group (8 trials; 446 participants; very low-certainty evidence); serious adverse events (RR 1.07; 95% CI 0.49 to 2.34); 13 trials; 988 participants; discharge on same day of surgery (RR 1.43; 95% CI 0.64 to 3.20; 3 trials; 242 participants; very low-certainty evidence). We found that intraperitoneal local anaesthetic probably results in a small reduction in length of hospital stay (MD -0.10 days; 95% CI -0.18 to -0.01; 12 trials; 936 participants; moderate-certainty evidence). No trials reported data on health-related quality of life, return to normal activity or return to work. Pain scores, as measured by visual analogue scale (VAS), were lower in the intraperitoneal local anaesthetic instillation group compared to the control group at both four to eight hours (MD -0.99 cm VAS; 95% CI -1.19 to -0.79; 57 trials; 4046 participants; low-certainty of evidence) and nine to 24 hours (MD -0.68 cm VAS; 95% CI -0.88 to -0.49; 52 trials; 3588 participants; low-certainty of evidence). In addition, we found two trials that were still ongoing, and one trial that was completed but with no published results. All three trials are registered on the WHO trial register. We are very uncertain about the effect estimate of intraperitoneal local anaesthetic for laparoscopic cholecystectomy on all-cause mortality, serious adverse events, and proportion of patients discharged on the same day of surgery because the certainty of evidence was very low. Due to inadequate reporting, we cannot exclude an increase in adverse events. We found that intraperitoneal local anaesthetic probably results in a small reduction in length of stay in hospital after surgery. We found that intraperitoneal local anaesthetic may reduce pain at up to 24 hours for low-risk patients undergoing laparoscopic cholecystectomy. Future randomised clinical trials should be at low risk of systematic and random errors, should fully report mortality and side effects, and should focus on clinical outcomes such as quality of life.

The effect of intraperitoneal ropivacaine on post-operative pain and recovery after diagnostic laparoscopy and hysteroscopy: A randomised double-blind placebo-controlled trial.

Intraperitoneal local anaesthetic has shown benefit in operative laparoscopy; however, no randomised controlled trial has been reported with patients having diagnostic laparoscopy. To determine the effect of intraperitoneal ropivacaine on post-operative analgesic requirements, pain, nausea scores and recovery following gynaecological diagnostic laparoscopy and hysteroscopy. Randomised double-blind placebo-controlled trial. Well women aged 18-50years, undergoing day case hysteroscopy and diagnostic laparoscopy for gynaecological indications were randomised to 20mL of 150mg intraperitoneal ropivacaine diluted in saline, or 20mL normal saline instillation (placebo) at the end of the procedure. Women were followed up until eight hours post-discharge. Slower than anticipated recruitment meant that the study was finished before the sample size of 100 patients was achieved. Fifty-nine patients were included for analysis. Thirty-one patients were randomised to ropivacaine and 28 patients to control. Sixty-one percent of patients in both arms required opioid medication in recovery. The total median equivalent morphine dose was significantly higher in the patients randomised to control (11.7 mg) vs ropivacaine (6.7mg), P=0.03. Time to discharge was 20min faster in patients randomised to ropivacaine, but this finding did not reach significance. Overall pain and nausea scores in the first eight hours showed no significant differences. There was significantly reduced opioid use in recovery when using intraperitoneal ropivacaine compared to placebo, in this randomised placebo-controlled trial on women undergoing day case diagnostic laparoscopy and hysteroscopy.

Effect of Local Anesthetics on Postoperative Pain in Patients Undergoing Gynecologic Laparoscopy: A Systematic Review and Meta-analysis of Randomized Trials

Pain remains a common complication after gynecologic laparoscopy. Use of local anesthesia may be beneficial in reducing postoperative pain. We performed a systematic review and meta-analysis to assess whether local anesthetic decreases postoperative pain after laparoscopic gynecologic procedures. We searched Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline from inception to November 2020 using Medical Subject Headings and free text combinations. We included randomized controlled trials of patients undergoing gynecologic laparoscopy receiving port site subcutaneous, subfascial, or intraperitoneal local anesthetic compared with placebo or no intervention. We included 20 trials (1861 participants) with size varying between 28 and 164 participants. Meta-analysis was performed with RevMan 5.3 (Cochrane Collaboration, London, United Kingdom), with standard mean differences (SMDs) and random-effects model. Port site infiltration reduces postoperative pain at 4 hours (SMD -0.25; 95% confidence interval [CI], -0.44 to -0.06; 4 trials; 545 participants) and 6 hours (SMD -0.44; 95% CI, -0.82 to -0.06; 4 trials; 455 participants) after surgery. The administration of intraperitoneal local anesthetics reduces pain at 6 hours (-1.42; 95% CI, -3.22 to -0.30; 4 trials; 277 participants) after surgery. The use of port site and intraperitoneal local anesthetic decreases immediate postoperative pain in patients undergoing gynecologic laparoscopy, although its impact on analgesia requirements is unclear. Routine usage of local anesthetics should be considered for people undergoing gynecologic laparoscopy.

Intraperitoneal local anesthesia for postoperative pain management in patients undergoing laparoscopic colorectal surgery: a systematic review and meta-analysis.

Intraperitoneal instillation of local anesthetic agents has been reported as an effective adjunct to pain management and early functional recovery in colorectal surgery. Laparoscopic colorectal resection (LCR) is considered as the gold standard approach to resect benign and malignant lesions of the colon and rectum due to the advantages of reduced pain score, quicker recovery, and shorter hospitalization. The objective of this study was to systematically analyze the published RCTs evaluating the effectiveness of intraperitoneal local anesthetic (IPLA) instillation versus standard analgesia in patients undergoing LCR. Electronic databases such as Embase, Medline, PubMed, PubMed Central and the Cochrane library pertaining to the use of IPLA infiltration after LCR were systematically reviewed using the principles of meta-analysis. Five RCTs on 292 patients undergoing LCR were either given IPLA or standard postoperative analgesia. In the random-effects model analysis using the statistical software Review Manager (Cochrane, London, UK), statistically 2-4 hours pain score (Standardized mean difference [SMD]=-1.72; 95% CI: -2.62 to -0.81; z=3.71; P=0.0002) was significantly lower in the IPLA group. The 12 hours postoperative pain score (P=0.23) was also lower in the IPLA group but failed to reach the statistical significance. Opioid analgesia requirement was lower in the IPLA group (SMD=-7.60; 95% CI: -11.21 to -3.90; z=4.12; P=0.0001) but the time to flatus, length of stay and the frequency of nausea/vomiting were statistically similar in both groups. IPLA instillation is an effective modality to reduce the postoperative pain score and lower the opioid analgesic requirements in patients undergoing LCR without influencing the time to first flatus, length of stay, and postoperative nausea/vomiting.

Comparison between ultrasound guided Transversus abdominis plane block and local anesthetic instillation in patients undergoing laparoscopic hysterectomy

Background: Post-laparoscopy analgesia is still a challenge. Many studies have been carried out to find the effect of different analgesic techniques in patients undergoing laparoscopic hysterectomy including ultrasonic guided TAP block and instillation of intraperitoneal local anesthetic.Aim: The aim of this study is to assess degree of pain control, duration of action, duration of postoperative analgesia, the effect on postoperative analgesic requirements in patients undergoing laparscopic hysterectomy and compare between Transversus abdominis plane block and intraperitoneal local anesthetics instillation.Materials and Methods: This study enrolled 50 cases for laparoscopic hysterectomy. They were divided randomly into two groups : TAP group (n=25) patients of this group received TAP block performed by ultrasound guidance and IPLA group (n=25) patients of this group received intraperitoneal local anesthetic (bupivacaine) instillation. After surgery, visual analogue score (VAS) was recorded at 1, 2,4,6,12,18 and 24 hours. Requirement of rescue analgesia when VAS score ≥ 4, total dose of morphine received in 24 h were noted in both groups postoperatively.Results: The overall VAS during the first postoperative 24 hours was significantly lower in TAP group (P = 0.048, 0.049, and 0.003 at 6, 12, 18 and 24 hours after surgery) and total analgesic consumption (morphine in mg) was lower (8.36 ± 1.98 mg) in TAP group (8.2 mg) compared to IPLA (12.24 ± 1.33 mg).Conclusion: TAP block provide better postoperative pain control and reduce postoperative opioid requirement in comparison with intraperitoneal local anesthetic instillation in patients undergoing laparscopic hysterectomy.

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.

Intraperitoneal ropivacaine reduces time interval to initiation of chemotherapy after surgery for advanced ovarian cancer: randomised controlled double-blind pilot study

BackgroundAdvanced-stage ovarian cancer has a poor prognosis; surgical resection with the intent to leave no residual tumour followed by adjuvant chemotherapy is the standard treatment. Local anaesthetics (LA) have anti-inflammatory and analgesic effects. We hypothesised that intraperitoneal LA (IPLA) would lead to improved postoperative recovery, better pain relief, and earlier start of chemotherapy. MethodsThis was a prospective, randomised, double-blind, placebo-controlled pilot study in 40 women undergoing open abdominal cytoreductive surgery. Patients were randomised to receive either intraperitoneal ropivacaine (Group IPLA) or saline (Group Placebo) perioperatively. Except for study drug, patients were treated similarly. Intraoperatively, ropivacaine 2 mg ml−1 or 0.9% saline was injected thrice intraperitoneally, and after operation via a catheter and analgesic pump into the peritoneal cavity for 72 h. Postoperative pain, time to recovery, home discharge, time to start of chemotherapy, and postoperative complications were recorded. ResultsNo complications from LA administration were recorded. Pain intensity and rescue analgesic consumption were similar between groups. Time to initiation of chemotherapy was significantly shorter in Group IPLA (median 21 [inter-quartile range 21–29] vs 29 [inter-quartile range 21–40] days; P=0.021). Other parameters including time to home readiness, home discharge and incidence, and complexity of postoperative complications were similar between the groups. ConclusionsIntraperitoneal ropivacaine during and for 72 h after operation after cytoreductive surgery for ovarian cancer is safe and reduces the time interval to initiation of chemotherapy. Larger studies are warranted to confirm these initial findings. Clinical trial registrationNCT02256228.

Perioperative Pain Control in Bariatric Surgeries, a Systematic Review

Abstract Introduction Research on adequate postoperative pain management is a current trend in post-anesthetic and surgical areas. Patient satisfaction is a parameter of medical quality. High pain scores increase the incidence of post-operative morbidity and lead to delayed recovery, prolonged hospital stay and increased healthcare costs.1 Bariatric Surgeries are surgeries performed for morbid obese patient to reduce patient’s weight through several methods and because morbid obese patients are at higher risk of complications after surgery2, Pain control during bariatric surgery is a major challenge3. Opioids play an important role in anesthesia practice; however, related complications like; sedation, airway obstruction, and respiratory depression are of concern in morbid obese patients .Therefore, opioids should be used sparingly. And newly safe methods better to be used for better perioperative pain control in bariatric surgeries. Objective To cover the gab of knowledge regarding the evidence of the safest and most efficient method to control perioperative pain in bariatric surgeries by reviewing the literature about this evidence through comparative systematic review study. Methodology Systematic review study discussed the results of 30 studies found in the literature related to perioperative pain control in bariatric surgeries according to the inclusion and exclusion criteria . Results and Discussion 30 different studies were discussed about the different methods of anesthesia in bariatric surgeries 6 of them about Transverses abdominis plane. ‘TAP’ block, 5 about Local anesthesia, 4 about Dexmedetomidine, 3 about spinal morphine, 3 about multi modal analgesia, 2 about preoperative medication, 2 about patient controlled analgesia ‘PCA', 1 about continuous infusion catheter, 1 about ibuprofen, 1 about Pulmonary recruitment maneuver, 1 about Sugammadex and 1 about non opioid anesthesia). Results are recorded about the efficacy of each method through the outcome measures. Conclusion It's found that the most effective method is multi modal analgesia represented in preoperative ultra sound guided TAP block, intraoperative port- sites and intraperitoneal infiltration with local anesthesia then recovery by sugammadex followed by postoperative IVI acetaminophen and PCA. Using preoperative clonidine, ketamine, pregabalin, epidural analgesia and pulmonary recruitment maneuver at the end of the surgery are also with low complication. Continuous infusion catheter, IV Ibuprofen, combined Dexmedetomidine and Acetaminophene, preoperative port-site infiltration and post operative intraperitoneal local anesthetic have no evidence based efficacy right now and it needs further studies.

Association between perioperative intraperitoneal local anaesthetic infusion and long-term survival and cancer recurrence after colectomy: follow-up analysis of a previous randomized controlled trial.

High concentrations of local anaesthetic have an anti-proliferative effect on colonic cancer in vitro. Intraperitoneal local anaesthetic (IPLA) has shown analgesic benefit and improved recovery in the perioperative setting. The long-term effects of IPLA in colon cancer resection have not been examined. This study aims to review the survival and oncological outcomes of a previously conducted trial that compared perioperative IPLA with placebo. Sixty patients underwent colonic resection for benign and malignant disease as part of a double-blinded, randomized, placebo-controlled study between September 2008 and November 2009. The IPLA group received instillation of intraperitoneal ropivacaine before dissection followed by a 3-day infusion. The placebo group was treated identically but with 0.9% saline solution. A follow-up analysis was conducted to evaluate overall survival, disease-free survival and recurrence specifically for patients undergoing resection for stages I-III colon cancer. Kaplan-Meier analysis was performed, and the log-rank test was used to evaluate difference in survival between groups. Thirty-seven of the 60 patients had stages I-III colon cancer and were included in this analysis. Nineteen patients were in the placebo group. There was no significant difference in overall survival or all-cause mortality. There was a higher incidence of cancer-specific mortality in the local anaesthetic group (P < 0.046). It does not appear that IPLA is associated with a significant survival benefit in patients with colonic malignancy undergoing colectomy. Other studies are needed to analyse the long-term outcomes.

Comparative evaluation of post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients undergoing laparoscopic cholecystectomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Laparoscopic cholecystectomy is commonly performed as a day care procedure for treating symptomatic gallstones. Suitability of patient discharge from the inpatient facility depends upon adequacy of postoperative pain control. Among the various modalities for pain relief, intraperitoneal local anaesthetic has become an important approach. In this study we aimed at comparing the post-operative analgesic effects of intraperitoneal levobupivacaine plus fentanyl and levobupivacaine plus tramadol in patients after laparoscopic cholecystectomy. The objective of this study was to determine which adjuvant drug was superior to the other in terms of prolonging the analgesic effects of levobupivacaine in post-operative period of laparoscopic cholecystectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 90 patients undergoing laparoscopic cholecystectomy were selected. They were divided into three groups: Group L- received 50 ml of 0.25% levobupivacaine; Group LT- received 0.25% of levobupivacaine and tramadol 2 ml (50 ml total); group LF- received 0.25% levobupivacaine plus fentanyl 2 ml (50 ml total). Postoperative pain was assessed using visual analogue scale.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The combination of levobupivacaine fentanyl and levobupivacaine tramadol&lt;strong&gt; &lt;/strong&gt;was superior to plain levobupivacaine for reducing postoperative pain. No significant difference was found between Group LT and LF with respect to first analgesic and total analgesic requirement. However significant difference was found between LF and L; and between LT and L.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Levobupivacaine should be used along with adjuncts either tramadol or fentanyl.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

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.

Intra-Peritoneal Local Anaesthetics in Ovarian Cancer

Intra-Peritoneal Local Anaesthetics in Ovarian Cancer

The LAPLAP study: a randomized placebo-controlled clinical trial assessing postoperative functional recovery using intraperitoneal local anaesthetic in laparoscopic colorectal surgery.

Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid-sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4-6ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3days postoperatively. Results were analysed in a double-blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Ninety-six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme.

The Use of Intraperitoneal Bupivacaine in Laparoscopic Roux-en-Y Gastric Bypass: a Double-blind, Randomized Controlled Trial.

Several studies have shown a reduction in postoperative pain and length of hospital stay when using intraperitoneal local anesthetics during laparoscopic surgery. In morbidly obese patients, respiratory depression due to opioid use is a serious side effect. Any different type of analgesia is therefore clinically relevant. To assess the effect of intraperitoneal bupivacaine on postoperative pain after laparoscopic Roux-en-Y gastric bypass (LRYGB). Between March and November 2017, 130 patients were included and randomly assigned to receive 20ml or 0ml of 2.5% bupivacaine hydrochloride sprayed onto the diaphragm. Pain scores for abdominal and shoulder pain were conducted using the visual analogue scale (VAS) for pain score at 0, 1, 6, and 24h postoperatively. The length of hospital stay and use of analgesics was recorded in digital patient records. The primary outcome is the pain scores and the secondary outcomes are postoperative use of opioids or antiemetics and length of hospital stay. The study and control group contained respectively 66 and 61 patients. Patient characteristics were equal in both groups (p < 0.05), except for age. No significant reduction of postoperative pain or opioid use was seen with the use of intraperitoneal bupivacaine. There was also no significant reduction in the use of antiemetics and length of hospital stay. The use of intraperitoneal bupivacaine in LRYGB does not show a statistically significant reduction in postoperative pain or postoperative opioid use. Therefore, using intraperitoneal bupivacaine has no clinical relevance and should no longer be used in LRYGB.

Pain management after laparoscopic hysterectomy: systematic review of literature and PROSPECT recommendations.

Laparoscopic hysterectomy is increasingly performed because it is associated with less postoperative pain and earlier recovery as compared with open abdominal hysterectomy. The aim of this systematic review was to evaluate the available literature regarding the management of pain after laparoscopic hysterectomy. Randomized controlled trials evaluating postoperative pain after laparoscopic hysterectomy published between January 1996 and May 2018 were retrieved, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, from the EMBASE and MEDLINE databases and the Cochrane Register of Controlled Trials. Efficacy and adverse effects of analgesic techniques were assessed. Of the 281 studies initially identified, 56 were included. Of these, 31 assessed analgesic or anesthetic interventions and 25 assessed surgical interventions. Acetaminophen, non-steroidal anti-inflammatory drugs, and dexamethasone reduced opioid consumption. Limited evidence hindered recommendations on alpha-2-agonists. Inconsistent evidence was found in the studies investigating pregabalin and transversus abdominis plane block, and no evidence was found for intraperitoneal local anesthetics, port site infiltration, or single-port laparoscopy. Measures to lower peritoneal insufflation pressure or humidify or heat insufflated gas seem to reduce the incidence of shoulder pain, but not abdominal pain. The baseline analgesic regimen for laparoscopic hysterectomy should include acetaminophen, a non-steroidal anti-inflammatory drug, dexamethasone, and opioids as rescue analgesics.

Interventions to reduce shoulder pain following gynaecological laparoscopic procedures.

Interventions to reduce shoulder pain following gynaecological laparoscopic procedures.