Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects.


METHODS
A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints.


RESULTS
The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects.


CONCLUSIONS
Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.
Papadima
Artemisia
A
Department of Anesthesiology, Hippocrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.
Lagoudianakis
Emmanuel E
EE
Antonakis
Pantelis
P
Filis
Konstantinos
K
Makri
Ira
I
Markogiannakis
Haridimos
H
Katergiannakis
Vaggelogiannis
V
Manouras
Andreas
A
D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002769:Cholelithiasis / Q000601:surgery; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007263:Infusions, Parenteral; D000077554:Levobupivacaine; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D011446:Prospective Studies
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008614:Meperidine; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine