title: Does Preincisional Infiltration with Bupivacaine Reduce Postoperative Pain in Laparoscopic Bariatric Surgery?
abstract: BACKGROUND
  Current evidence suggests that local anesthetic wound infiltration should be employed as part of multimodal postoperative pain management. There is scarce data concerning the benefits of this anesthetic modality in laparoscopic weight loss surgery. Therefore, we analyzed the influence of trocar site infiltration with bupivacaine on the management of postoperative pain in laparoscopic bariatric surgery.
  
  
  METHODS
  This retrospective randomized study included 47 patients undergoing primary obesity surgery between January and September 2014. Laparoscopic gastric bypass was performed in 39 cases and sleeve gastrectomy in 8 cases. Patients were stratified into two groups depending on whether preincisional infiltration with bupivacaine and epinephrine was performed (study group, 27 patients) or not (control group, 20 patients). Visual analogue scale (VAS), International Pain Outcomes questionnaire, and rescue medication records were reviewed to assess postoperative pain.
  
  
  RESULTS
  VAS scores in the study group and sleeve gastrectomy group were lower than those in the control and gastric bypass groups in the first 4 h postoperatively without reaching statistical significance (p > 0.05). VAS scores did not differ in any other period of time. No statistically significant differences in pain perception were registered according to the patient's pain outcomes questionnaire or the need for rescue medication.
  
  
  CONCLUSIONS
  The present study did not conclusively prove the efficacy of bupivacaine infiltration by any of the three evaluation methods analyzed. Nevertheless, preincisional infiltration provides good level of comfort in the immediate postoperative period when analgesia is most urgent.
authors.affiliation: Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. rmoncada@unav.es.|Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain. rmoncada@unav.es.
authors.forename: Rafael
authors.initials: R
authors.lastname: Moncada
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. linasm@yahoo.com.
authors.forename: Linas
authors.initials: L
authors.lastname: Martinaitis
authors.affiliation: Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain.|TRUEHF, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Landecho
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. frotellar@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain. frotellar@unav.es.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rotellar
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. csjusticia@unav.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sanchez-Justicia
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. mbellver@icloud.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bellver
authors.affiliation: Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. mhiguera@unav.es.
authors.forename: Magdalena
authors.initials: M
authors.lastname: de la Higuera
authors.affiliation: Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. csilva@unav.es.
authors.forename: Camilo
authors.initials: C
authors.lastname: Silva
authors.affiliation: Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. beaoses2010@hotmail.com.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Osés
authors.affiliation: Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. elenammgg@hotmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Martín
authors.affiliation: Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. spmendioroz@unav.edu.
authors.forename: Susana
authors.initials: S
authors.lastname: Pérez
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. jlhernande@unav.es.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Hernandez-Lizoain
authors.affiliation: CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain. gfruhbeck@unav.es.|Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. gfruhbeck@unav.es.|Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain. gfruhbeck@unav.es.|Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. gfruhbeck@unav.es.
authors.forename: Gema
authors.initials: G
authors.lastname: Frühbeck
authors.affiliation: Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain. vvalenti@unav.es.|CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain. vvalenti@unav.es.|Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Navarra, Spain. vvalenti@unav.es.|Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain. vvalenti@unav.es.
authors.forename: Victor
authors.initials: V
authors.lastname: Valentí
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D050110:Bariatric Surgery; D002045:Bupivacaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010149:Postoperative Pain / Q000517:prevention & control*; D011300:Preoperative Care; D011897:Random Allocation; D012189:Retrospective Studies; D013525:Surgical Instruments
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine
keywords: Bupivacaine; Laparoscopic bariatric surgery; Postoperative pain; Preincisional infiltration; Trocar site infiltration