title: Effect of bupivacaine after operative laparoscopic gynecologic procedures.
abstract: OBJECTIVE
  To evaluate the effect of intraperitoneal installation and periportal infiltration of bupivacaine on postoperative pain and return of bowel function.
  
  
  METHODS
  A prospective, double-blind, randomized trial (Canadian Task Force classification I).
  
  
  METHODS
  GATA School of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit.
  
  
  METHODS
  Eighty patients undergoing operative gynecologic laparoscopy.
  
  
  METHODS
  Periportal infiltration of local anesthesia with 10 mL 0.5% bupivacaine before incision and another 20 mL 0.5% bupivacaine diluted with 20 mL of saline or equal amount of physiologic saline injected into the peritoneal cavity at the end of the procedure.
  
  
  RESULTS
  Each patient recorded the severity of her pain on a visual analog scale (VAS) at 1, 6, 18, and 24 hours and the time of first bowel movement and first flatus after surgery. Seventy-seven patients completed the study (38 in the bupivacaine group; 39 in the control group). The severity of postoperative pain, as recorded on the VAS, was significantly less at 1, 6, 18, and 24 hours after surgery in the group receiving bupivacaine compared with those in the control group. The first bowel movement in the bupivacaine group occurred earlier than in the control group (284.80 +/- 31.62 min vs 453.23 +/- 33.08 min, p <.001); similarly, the first flatus occurred earlier in the bupivacaine group than in the control group (466.2 +/- 29.59 min vs 658.80 +/- 40.92 min p <.001).
  
  
  CONCLUSIONS
  Intraperitoneal installation and periportal infiltration of bupivacaine decrease postoperative pain and hasten the return of bowel function. Both decreased postoperative pain and shortened duration for the return of bowel function are crucial for comfort and discharge of the patient.
authors.affiliation: Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit, Gulhane Military Medical Academy and Medical School, Ankara, Turkey. stceyhan@gata.edu.tr
authors.forename: Temel
authors.initials: T
authors.lastname: Ceyhan
authors.forename: Ertan
authors.initials: E
authors.lastname: Teksoz
authors.forename: Sadettin
authors.initials: S
authors.lastname: Gungor
authors.forename: Umit
authors.initials: U
authors.lastname: Goktolga
authors.forename: Recai
authors.initials: R
authors.lastname: Pabuccu
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000494:pharmacology / Q000627:therapeutic use; D002045:Bupivacaine / Q000494:pharmacology / Q000627:therapeutic use; D003672:Defecation / Q000187:drug effects*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D010535:Laparoscopy; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine