Postoperative pain control after microlaparoscopy in patients with infertility: a prospective randomized study.
OBJECTIVE
To evaluate the efficacy of intraperitoneal subdiaphragmatic instillation of lidocaine and trocar site infiltration of bupivacaine to minimize postoperative pain after diagnostic microlaparoscopy performed under local anesthesia with conscious sedation.


METHODS
Prospective randomized study.


METHODS
Day-surgery unit of Endogyn Service, Naples, and Department of Gynecologic and Pediatric Sciences, Reggio Calabria University, Catanzaro, Italy.


METHODS
Sixty-one women with infertility.


METHODS
All patients received local anesthesia and conscious sedation before surgery. After the microlaparoscopy, the treatment group was given 40 mL of intraperitoneal subdiaphragmatic 0.5% lidocaine and 5 mL of 0.5% bupivacaine that was infiltrated into the trocar insertion sites. The control group received no treatment. When necessary, ketoprofene or ketorolac were administered IM after surgery.


METHODS
Postoperative pain was evaluated with the use of a visual analog scale with scores ranging from 1-10 immediately after surgery and over the next 48 hours. The rate at which patients were discharged from the hospital 2 hours after surgery also was recorded.


RESULTS
The treatment group had significantly lower pain scores both immediately after surgery and 1, 3, and 6 hours afterward. The need for postoperative analgesics also was significantly lower in the treatment group. The rate at which patients were discharged 2 hours after surgery was significantly higher in the treatment group.


CONCLUSIONS
Postoperative intraperitoneal lidocaine administration and bupivacaine infiltration of the trocar sites is beneficial for patients undergoing microlaparoscopy. The effect of these drugs is temporary, but they can significantly decrease postoperative pain for approximately 6 hours and reduce the need for additional analgesics. Most important, the rate at which patients can be discharged from the hospital only 2 hours after surgery is increased significantly.
Endogyn Service, Private Endoscopic Associates, Naples, Italy. PELLICAN@CDS.UNINA.IT
M
M
Pellicano
F
F
Zullo
C
C
Di Carlo
E
E
Zupi
C
C
Nappi
D000328:Adult; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000601:surgery*; D007274:Injections, Intraperitoneal; D010535:Laparoscopy / Q000379:methods*; D008012:Lidocaine / Q000627:therapeutic use; D008866:Microsurgery / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine