Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial.
OBJECTIVE
A randomized controlled trial of patients undergoing laparoscopic cholecystectomy. To evaluate whether the instillation of levobupivacaine, with epinephrine, intraperitoneally, reduces morphine consumption; further, to consider the degree of abdominal and shoulder pain in the presence of local anaesthetic at the site of surgical incision.


METHODS
Patients received a standardized procedure and were allocated randomly to receive either (a) 2.5 mg mL(-1) levobupivacaine 30 mL, with epinephrine 5 microg mL(-1), or (b) normal saline 30 mL, with epinephrine 5 microg mL(-1), to the bed of the gall bladder and above the liver, immediately before wound closure.


RESULTS
Median (interquartile range) total abdominal pain during inspiration in the levobupivacaine group was significantly (P = 0.041) lower (71 (21-129) mm) than that in the placebo group (123 (71-179) mm). However, there was no significant difference between the two groups with respect to total abdominal pain at rest, right shoulder pain or the consumption of rescue morphine and rescue dihydrocodeine. There were no differences between the two groups with respect to the administration of cyclizine, total nausea and total sedation scores. In addition, the number of episodes of vomiting was not significantly different.


CONCLUSIONS
Intraperitoneal administration of levobupivacaine with epinephrine is associated with modest analgesia following laparoscopic cholecystectomy.
Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care and Pain Management, Leicester, UK. anae@le.ac.uk
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D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D004311:Double-Blind Method; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007274:Injections, Intraperitoneal; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine; D004837:Epinephrine