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.