The effect of intraoperative bupivacaine administration on parenteral narcotic use after laparoscopic appendectomy.
BACKGROUND
Little is known about the effect that prophylactic administration of local anesthesia into surgical incisions has on pain and analgesic use after laparoscopic appendectomy. We examined how preemptive infiltration of a local anesthetic affected the use of parenteral narcotics after laparoscopic appendectomy.


METHODS
We conducted a retrospective chart review of 60 patients who underwent a laparoscopic appendectomy from January 2000 to April 2001 at our institution. We studied the association between prophylactic bupivacaine analgesia and patterns of postoperative parenteral narcotic use.


RESULTS
Of 46 patients who received intraoperative bupivacaine, 24 (52%) required postoperative parenteral narcotics as compared with 12 (86%) of 14 patients who did not receive bupivacaine (risk difference, 34%; 95% confidence interval [CI], 10-51%; p = 0.02). After adjustment for other factors, the patients who received prophylactic bupivacaine were much less likely to receive parenteral narcotics during their postoperative hospital stay than the patients who did not receive prophylactic bupivacaine (odds ratio, 0.2; 95% CI, 0.1-0.9; p = 0.03). Furthermore, the patients who received prophylactic bupivacaine required fewer doses (median number of doses, 0.5; interquartile range [IQR], 0-2) of parenteral narcotics postoperatively than those who did not receive bupivacaine (median, 2; IQR, 1-4; p value for comparison, 0.03).


CONCLUSIONS
Intraoperative bupivacaine infiltrated locally into surgical wounds is associated with both a decreased need for postoperative parenteral narcotics and a reduced number of doses in patients who have undergone a laparoscopic appendectomy.
Cervini
P
P
Minimally Invasive Surgery Program, Division of General Surgery, Toronto Western Hospital, 399 Bathurst Street, Room MP 8-332, Toronto, Ontario M5T 2S8.
Smith
L C
LC
Urbach
D R
DR
D000328:Adult; D000367:Age Factors; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D001062:Appendectomy / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D007430:Intraoperative Care / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use*; D010149:Postoperative Pain / Q000517:prevention & control; D011182:Postoperative Care / Q000379:methods; D012737:Sex Factors; D016896:Treatment Outcome
D000779:Anesthetics, Local; D009294:Narcotics; D002045:Bupivacaine