A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy.
BACKGROUND
Intraperitoneal local anesthesia has been reported to reduce postoperative pain after laparoscopy for gynecologic procedures that do not require a great deal of dissection or manipulation of viscera. This study was performed to determine the efficacy of intraperitoneal bupivacaine in laparoscopic cholecystectomy (LC).


METHODS
Fifty-five patients were evaluable in this randomized, double-blind, placebo-controlled study. Twenty-six patients received bupivacaine (0.1%) and 29 patients received placebo (saline). Prior to any dissection of the gallbladder, the surgeon irrigated 100 ml of experimental solution under the right hemidiaphragm, over Glisson's capsule, over the gallbladder serosa, and into the subhepatic space. The operation was then performed as usual. Postoperatively, analgesic medication usage, nausea, vomiting, and pain scores were determined during hospitalization. A questionnaire was given to each patient upon discharge from the hospital in order to continue monitoring medications and pain for the first 48 h at home.


RESULTS
Postoperative pain was reduced significantly (P < 0.05) in the patients who received bupivacaine, but the effect was modest and observable only during the first 6 h after surgery. Despite this difference, there was no significant reduction in the amount of analgesic medication used by the patients who received bupivacaine, nor was there any reduction in nausea, vomiting, or shoulder pain when queried specifically.


CONCLUSIONS
Intraperitoneal bupivacaine offered a detectable, albeit subtle benefit to patients undergoing LC. However, the effect was transient and had little impact upon the patient's convalescence.
Szem
J W
JW
Department of Surgery, New York Hospital-Cornell Medical Center, NY 10021, USA.
Hydo
L
L
Barie
P S
PS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005069:Evaluation Studies as Topic; D006801:Humans; D007274:Injections, Intraperitoneal; D008875:Middle Aged; D009325:Nausea / Q000517:prevention & control*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010351:Patient Discharge; D010919:Placebos; D011183:Postoperative Complications / Q000517:prevention & control*; D012965:Sodium Chloride; D013997:Time Factors; D014839:Vomiting / Q000517:prevention & control
D000700:Analgesics; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010919:Placebos; D012965:Sodium Chloride; D002045:Bupivacaine