Introduction
One of the techniques for reducing pain and opiate demand after surgery
is the use of local anesthesia in surgical incisions1. It has been shown that nociceptive stimuli can
alter the electrophysiological processes in the neurons2.This alteration results in a lower pain threshold
and an increased response to pain stimuli.
By infiltrating a local anesthetic before the incision is made, these
effects should in theory be avoided. This, in turn, can potentially
increase mobilization and shorten hospitalization after surgery1.
In an attempt to reduce postoperative pain following laparoscopy, a
variety of methods of perioperative local analgesia have been studied.
Injection of preemptive local anesthetics into the trocar sites has been
shown to be beneficial in reducing postoperative pain during ambulation3, whereas administration of intraperitoneal
anesthetics at the end of surgery was found to be effective in reducing
intensity of postoperative abdominal pain 4,5, as well
as shoulder-tip pain 6. However, a few studies failed
to show these beneficial effects of both trocar site local anesthesia7, and the intraperitoneal anesthesia8,9. A recent systematic review by Long et al.10 examined the evidence regarding the practice of
preemptive analgesia administration; they reported that laparoscopic
incisional infiltration has a modest effect, although data regarding
this intervention are inconclusive. In addition, intraperitoneal
analgesia was reported to likely be beneficial for postoperative pain
control 10. Nevertheless, the combination of
incisional site and intraperitoneal analgesia has rarely been studied,
and the evidence is conflicting 11–14.
Therefore, our goal was to study how administration of preemptive
incisional site subcutaneous (SC) anesthetics, combined with-operative
intraperitoneal (IP) analgesia, affects postoperative pain levels
(abdominal and shoulder-tip) among patients undergoing operative
gynecologic laparoscopy.