A randomized double-blind study to evaluate asurgeon-based technique to reduce post-operative pain in minimal gynecological surgery

Authors

  • Asif Mustafa Department of Obstetrics and Gynaecology, Max Smart Super Specialty Hospital, New Delhi, India
  • Manju Khemani Department of Obstetrics and Gynaecology, Max Smart Super Specialty Hospital, New Delhi, India
  • Deepika Verma Department of Obstetrics and Gynaecology, Max Smart Super Specialty Hospital, New Delhi, India
  • Mukul Chandra Kapoor Department of Anaesthesiology, Max Smart Super Specialty Hospital, New Delhi, India
  • Bela Makhija Department of Obstetrics and Gynaecology, Max Smart Super Specialty Hospital, New Delhi, India
  • Ruchi Bhandari Department of Obstetrics and Gynaecology, Max Smart Super Specialty Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20231535

Keywords:

Levo-Bupivacaine, Intraperitoneally, Rescue analgesia, Laparoscopic surgery, Post-operative pain relief

Abstract

Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale.

Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I & II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group.

Results: Mean pain scores were significantly lower (p<0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group.

Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery.

References

Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analges. 1995;81(2):379-84.

Hernandez-Palazon J, Tortosa JA, De La Rosa VN, Giménez-Viudes J, Ramírez G, Robles R. Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaesthesiol. 2003;20(11): 891-6.

MraoviČ B, Jurišič T, Kogler‐Majeric V, Sustic A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 1997;41(2):193-6.

Pasqualucci A, De Angelis V, Contardo R, Colo F, Terrosu G, Donini A, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. J Am Soc Anesthesiol. 1996; 85(1):11-20.

Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analges. 2000; 91(2):403-7.

Shalan H, Badawy A, Yousef H, Nazar M. Effect of intraperitoneal bupivacaine on postoperative pain following laparoscopic pelvic surgery. Gynaecol Endoscopy. 2002;11(6):371-5.

Helvacioglu A, Weis R. Operative laparoscopy and postoperative pain relief. Fertil Sterility. 1992;57(3): 548-52.

Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet. 1991;338(8782-3):1569-70.

Callesen T, Hjort D, Mogensen T, Schouenborg L, Nielsen D, Reventlid H, et al. Combined field block and ip instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth. 1999; 82(4):586-90.

Butala BP, Shah VR, Nived K. Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries. Saudi J Anaesth. 2013;7(1): 18.

Ismail MT, Hassanin MZ, Elshmaa NS. Preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25% for management of early postoperative pain following laparoscopic ovarian drilling. J Obstet Gynaecol Res. 2013;39(2):543-8.

Burlacu CL, Buggy DJ. Update on local anesthetics: focus on levobupivacaine. Therap Clin Risk Management. 2008;4(2):381.

Berde CB, Strichartz GS. Local Anesthetics. In: Miller RD, Cohen NH, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Young WL, eds. Miller’s Anesthesia. 8th ed. Philadelphia: Elsevier Saunders; 2015;23:1028-52.

Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP. Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%. Surg Endos Other Intervent Tech. 2005;19(11):1503-6.

Alper I, Ulukaya S, Ertugrul V, Makay O, Uyar M, Balcioglu T. Effects of intraperitoneal levobupivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized, double-blinded study. Agri. 2009;21(4):141-5.

Govil N, Kumar P. Intraperitoneal levobupivacaine with or without clonidine for pain relief after laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled trial. Anesthesia, Essays Res. 2017;11(1):125.

Papagiannopoulou P, Argiriadou H, Georgiou M, Papaziogas B, Sfyra E, Kanakoudis F. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endos Other Intervent Tech. 2003;17(12):1961-4.

Cunningham TK, Draper H, Bexhell H, Allgar V, Allen J, Mikl D, Phillips K. A double-blinded randomised controlled study to investigate the effect of intraperitoneal levobupivacaine on post laparoscopic pain. Facts Views Vision Obstet Gyncol. 2020;12(3): 155.

Gluck O, Barber E, Feldstein O, Tal O, Kerner R, Keidar R, et al. The effect of subcutaneous and intraperitoneal anesthesia on post laparoscopic pain: a randomized controlled trial. Sci Rep. 2021;11(1):1-8.

Downloads

Published

2023-05-26

Issue

Section

Original Research Articles