THE EFFECT OF SUBCUTANEOUS AND INTRAPERITONEAL ANESTHESIA ON POST
LAPAROSCOPIC PAIN: A RANDOMIZED CONTROLLED TRIAL
Abstract
Objective: to evaluate whether subcutaneous and/ or intraperitoneal
analgesia reduce pain after laparoscopy. Design: a double blinded,
randomized trial. Setting: A gynecologic surgery unit at a tertiary
medical center. Population: Patients who underwent elective laparoscopy
for benign indications were randomly assigned to one of four groups:
subcutaneous and intraperitoneal analgesia; subcutaneous analgesia and
intraperitoneal placebo; subcutaneous placebo and intraperitoneal
analgesia; subcutaneous and intraperitoneal placebo. Exclusion criteria
were: active infection, pregnancy, known sensitivity to
Bupivacaine-Hydrochloride, chronic pelvic pain, surgeries with
additional vaginal procedures, conversion to laparotomy, and malignancy.
Methods: prior to skin incision, either 9ml Bupivacaine hydrochloride
0.5% or 9ml Sodium Chloride 0.9% (as placebo) were injected
subcutaneously to three trocar sites. Upon completion of surgery, either
10ml Bupivacaine hydrochloride 0.5%, diluted with 40ml Sodium Chloride
0.9% (50ml total solution), or 50ml Sodium Chloride 0.9% (as placebo),
were instilled intraperitoneally. Main Outcome Measures: the primary
outcome was the level of abdominal pain during ambulation at 8 hours
following surgery. Secondary outcomes included level of pain felt at
rest at 3, 8, and 24 hours, and during ambulation at 24 hours following
surgery, and analgesics requirement. Results: one hundred and nineteen
women were included in the study. Demographic and interventional
characteristics were similar among the groups. The level of
postoperative pain, either at rest or with change of position , was not
significantly different between the groups, at all time points.
Conclusions: Application of subcutaneous and/or intraperitoneal
analgesia is not effective in reducing pain after laparoscopy.