title: Intraperitoneal local anaesthetic in abdominal surgery - a systematic review.
abstract: BACKGROUND
  The use of intraperitoneal local anaesthetic (IPLA) can be used to modulate visceral nociception after abdominal surgery; however, this technique is not routinely used in open abdominal surgery. The aim of this systematic review was to appraise the clinical effects of IPLA in open abdominal surgery for metachronous outcomes including pain, metabolic response to surgery and gastrointestinal function.
  
  
  METHODS
  A comprehensive search was conducted independently without language restriction. Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Post-operative clinical and metabolic outcomes of randomized controlled trials comparing IPLA versus no IPLA or placebo solution were used for meta-analysis.
  
  
  RESULTS
  Twelve trials were identified including eight randomized trials in gastrointestinal and gynaecological surgery. Post-operative pain was reduced but not opioid use. There was blunting of postoperative hyperglycaemia. There was no difference in post-operative cortisol response. Return of bowel function appeared to be quickened, although meta-analysis was not possible.
  
  
  CONCLUSIONS
  The use of IPLA is safe and appears to have clinical benefits. However this technique has not been studied in optimized perioperative settings. Trials are needed to evaluate this method of visceral blockade further after major abdominal surgery.
authors.affiliation: Department of Surgery, University of Auckland, South Auckland Clinical School, Middlemore Hospital, New Zealand. arman.kahokehr@middlemore.co.nz
authors.forename: Arman
authors.initials: A
authors.lastname: Kahokehr
authors.forename: Tarik
authors.initials: T
authors.lastname: Sammour
authors.forename: Mattias
authors.initials: M
authors.lastname: Soop
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Hill
mesh_terms: D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D013505:Digestive System Surgical Procedures; D006801:Humans; D007274:Injections, Intraperitoneal; D007430:Intraoperative Care / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*
chemical_list: D000779:Anesthetics, Local