title: Preemptive analgesia installation during gynecologic laparoscopy: a randomized trial.
abstract: OBJECTIVE
  To evaluate the efficacy of intraoperative infusion of bupivacaine solution for the relief of pain after operative gynecologic laparoscopy.
  
  
  METHODS
  Prospective, double-blind, randomized, controlled trial (Canadian Task Force classification I4).
  
  
  METHODS
  Tertiary teaching hospital.
  
  
  METHODS
  Ninety-one women aged 16 to 69 years who underwent gynecologic laparoscopic surgery from November 2002 through November 2003.
  
  
  METHODS
  Group A (n = 30): intraperitoneal infusion of a mixture of 10 mL of 0.5% bupivacaine (50 mg) with epinephrine (1:500) in 40 mL of Ringer's lactate solution postoperatively. Group B (n = 30): the same mixture solution infusion preoperatively and postoperatively (total 100 mg bupivacaine). Group C (n = 31): placebo.
  
  
  RESULTS
  Shoulder tip pain (STP), abdominal parietal pain (APP), and abdominal visceral pain (AVP) were recorded on a visual analog scale at 2, 4, 8, 16, and 24 hours postoperatively. A total of 79 patients fulfilled the study criteria. The overall incidence of STP was 60.8%. Abdominal visceral pain in group B was significantly less than in group C at 2 and 4 hours postoperatively (p = .011 and p = .010, respectively). No statistically significant difference was found in length of hospital stay, postoperative meperidine consumption, or side effects.
  
  
  CONCLUSIONS
  Intraperitoneal bupivacaine administration both immediately after placement of trocars and at the end of surgery was found to be effective in reducing the intensity of AVP but not in reducing STP, APP, or postoperative analgesia consumption after nonadvanced gynecologic laparoscopic procedures. The duration of the analgesic effect of bupivacaine instilled into the peritoneal cavity did not exceed 8 hours and probably was not dose related.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
authors.forename: Yin-Jou
authors.initials: YJ
authors.lastname: Chou
authors.forename: Yu-Che
authors.initials: YC
authors.lastname: Ou
authors.forename: Kuo-Chung
authors.initials: KC
authors.lastname: Lan
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Shiuh-Young
authors.initials: SY
authors.lastname: Chang
authors.forename: Fu-Tsai
authors.initials: FT
authors.lastname: Kung
mesh_terms: D015746:Abdominal Pain / Q000517:prevention & control*; D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007263:Infusions, Parenteral; D010535:Laparoscopy; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control*; D011300:Preoperative Care
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine