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THE EFFECT OF SUBCUTANEOUS AND INTRAPERITONEAL ANESTHESIA ON POST LAPAROSCOPIC PAIN: A RANDOMIZED CONTROLLED TRIAL
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  • Ohad Gluck,
  • Elad Barber,
  • Ohad Feldstein ,
  • Ori Tal,
  • Ram. Kerner,
  • Ran Keidar,
  • Inna Wolfson,
  • Shimon Ginath,
  • Jacob Bar,
  • Ron Sagiv
Ohad Gluck
Edith Wolfson Medical Center
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Elad Barber
Edith Wolfson Medical Center
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Ohad Feldstein
Edith Wolfson Medical Center
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Ori Tal
Edith Wolfson Medical Center
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Ram. Kerner
Edith Wolfson Medical Center
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Ran Keidar
Edith Wolfson Medical Center
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Inna Wolfson
Edith Wolfson Medical Center
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Shimon Ginath
Edith Wolfson Medical Center
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Jacob Bar
Edith Wolfson Medical Center
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Ron Sagiv
Edith Wolfson Medical Center
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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.