The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis.
Intraperitoneal administration of local anesthesia is often used to improve pain relief after laparoscopic cholecystectomy. We have conducted a meta-analysis to establish the efficacy of this technique in reducing early postoperative abdominal pain. A systematic literature search revealed 24 randomized, controlled trials assessing intraperitoneal local anesthetic use in laparoscopic cholecystectomy that met inclusion criteria. Of these, 16 studies reported sufficient data to allow pooled quantitative analysis. The weighted mean differences (WMD) in visual analog pain score at 4 h after surgery were pooled using a random effects model. Overall, the use of intraperitoneal local anesthesia resulted in a significantly reduced pain score at 4 h (WMD, -9 mm; 95% confidence interval [CI], -13 to -5). Subgroup analysis suggested that the effect was greater when the local anesthetic was given at the start of the operation (WMD, -13 mm; 95% CI, -19 to -7) compared with instillation at the end (WMD, -6 mm; 95% CI, -10 to -2). No adverse events related to local anesthetic toxicity were reported. We conclude that the use of intraperitoneal local anesthesia is safe, and it results in a statistically significant reduction in early postoperative abdominal pain.
Boddy
Alexander P
AP
Department of General Surgery, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom. mr@lapsurgeon.co.uk
Mehta
Samir
S
Rhodes
Michael
M
D015746:Abdominal Pain / Q000188:drug therapy*; D000779:Anesthetics, Local / Q000494:pharmacology*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D002986:Clinical Trials as Topic; D006801:Humans; D007263:Infusions, Parenteral; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
D000779:Anesthetics, Local