title: Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial.
abstract: BACKGROUND
  Laparoscopic strategies for managing intraabdominal pathologies offer significant benefits compared with conventional approaches. Of interest are reports of decreased postoperative pain, resulting in shorter hospitalization and earlier return to normal activity. However, many patients still require strong analgesia postoperatively. This study analyzed the use of intraoperatively delivered aerosolized intraperitoneal bupivacaine and its ability to reduce postoperative pain.
  
  
  METHODS
  For this study, 80 patients undergoing laparoscopic cholecystectomy were recruited and divided randomly into four groups: control (n = 20), aerosolized bupivacaine (n = 20), aerosolized normal saline (n = 20), and local bupivacaine in the bladder bed (n = 20). All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were recorded by the nursing staff in recovery, then 6, 12, and 24 h postoperatively using a standard 0 to 10 pain scoring scale. In addition, opiate consumption and oral analgesia were recorded.
  
  
  RESULTS
  Aerosolized bupivacaine significantly reduced postoperative pain in comparison with all other treatments (p < 0.05). Injection of bupivacaine into the gallbladder bed did not result in a significant difference from the control condition.
  
  
  CONCLUSIONS
  Aerosolized intraperitoneal local anesthetic is an effective method for controlling postoperative pain. It significantly helped to reduce opiate use and contributed to rapid mobilization, leading to short hospitalization and possible reduction in treatment cost.
authors.affiliation: Department of Biosurgery and Technology, Imperial College London, 10th Floor, QEQM Building, St. Mary's Hospital, Praed Street, London, W2 1NY, UK. n.alkhamesi@imperial.ac.uk
authors.forename: N A
authors.initials: NA
authors.lastname: Alkhamesi
authors.forename: D H
authors.initials: DH
authors.lastname: Peck
authors.forename: D
authors.initials: D
authors.lastname: Lomax
authors.forename: A W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D000328:Adult; D000336:Aerosols / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007274:Injections, Intraperitoneal; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D011336:Probability; D016896:Treatment Outcome
chemical_list: D000336:Aerosols; D000779:Anesthetics, Local; D002045:Bupivacaine