A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparoscopic Roux-en-Y gastric bypass.
BACKGROUND
Intraperitoneal local anesthetics have been investigated in several laparoscopic procedures that demonstrate improved postoperative pain control and reduced length of hospital stay. No published studies to date address the effectiveness of IP local anesthetics in laparoscopic gastric bypass patients (LRYGB).


METHODS
Between October 2004 and March 2005, 133 patients were prospectively studied to evaluate the efficacy of IP bupivacaine (IPB) in LRYGB. Patients were randomized to receive either bupivacaine (study group) or saline (control group), which was administered over the esophageal hiatus before dissection and bypass. All procedures were performed in a University-affiliated community-based hospital by three experienced laparoscopic gastric bypass surgeons. Outcomes variables included postoperative pain and narcotic use, length of stay, antiemetic use, cost, and pulmonary function.


RESULTS
There were 65 patients within the study group and 68 control patients, with equivalent patient demographics (p > 0.05). A statistically significant decrease in oral narcotic (hydrocodone/acetaminophen, Lortab Elixir, UCB) use was seen in the experimental group relative to the control group (23.8 +/- 2.2 mL versus 33.7 +/- 3.0 mL). Material cost was greater by $0.36 per patient in the study group. All other outcomes variables (ie, length of stay, postoperative IV narcotic use, incentive spirometer volumes, visual analog pain scale, and antiemetic use) showed no considerable differences.


CONCLUSIONS
IPB use during LRYGB revealed a statistically significant difference only in postoperative oral narcotic use. Possibly, the IPB can limit or prevent peritoneal irritation and reduce the need for longer narcotic use. Clinical significance was not demonstrated by our outcomes variables.
Symons
Jamie L
JL
Grand Rapids, Michigan State University General Surgery Residency, Grand Rapids Medical Education and Research Center, Spectrum Health, Grand Rapids, MI, USA.
Kemmeter
Paul R
PR
Davis
Alan T
AT
Foote
James A
JA
Baker
Randal S
RS
Bettendorf
Matthew J
MJ
Paulson
Jayne E
JE
D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D007274:Injections, Intraperitoneal; D007432:Intraoperative Period; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome
D000779:Anesthetics, Local; D002045:Bupivacaine