Skip to main content

Advertisement

SpringerLink
Log in

Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy

  • Original article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background: Postoperative pain is less intense after laparoscopic surgery than after open surgery. However, patients may gain additional benefit from a preincisional local infiltration of anesthetic. The aim of this study was to compare the analgesic efficacy of two local anesthetics, ropivacaine and levobupivacaine, for tissue infiltration as a means of improving postoperative pain control after laparoscopic cholecystectomy.Methods: Using a randomized, double-blind study design, 57 American Society of Anesthesiologists (ASA) I and II patients scheduled for laparoscopic cholecystectomy were randomly assigned to receive local infiltration with 0.9% saline solution (Placebo group, n = 18), ropivacaine 1% (Rop group, n = 20), or levobupivacaine 0.5% (Lev group, n = 19). The local anesthetic was administered, prior to trocar placement, using the same technique and delivering the same volume (20 ml) for all three groups. The anesthetic technique was standardized for all groups. Postoperative pain was rated at 2 h, 4 h, and 24 h postoperatively by visual analogue scale (VAS) score. Cumulative analgesic consumption and adverse effects were also recorded. Data were analyzed by analysis of variance (ANOVA), followed by a post hoc test.Results: The Lev and Rop groups did not differ significantly in their VAS scores at 2 h postoperatively, but the Lev group experienced significantly (p < 0.001) less pain than the Placebo and Rop groups at 4 h and 24 h postoperatively. The Rop group registered significantly lower VAS scores (p < 0.001) than the Placebo group at 4 h postoperatively. Additionally, the consumption of analgesics was significantly lower in the Lev group than in the Rop (p < 0.01) and Placebo (p < 0.001) groups, and patients in the Rop group consumed significantly less analgesics (p < 0.001) than the to patients in the Placebo group.Conclusion: Local tissue infiltration with levobupivacaine is more effective than ropivacaine in reducing the postoperative pain associated with laparoscopic cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2

Similar content being viewed by others

References

  1. C Aps F Reynolds (1978) ArticleTitleAn intradermal study of the local anaesthetic and vascular effects of the isomers of bupivacaine. Br J Clin Pharmacol 6 63–68 Occurrence Handle1:CAS:528:DyaE1cXlsFOmt7o%3D Occurrence Handle666948

    CAS  PubMed  Google Scholar 

  2. M Bay-Nielsen B Klarsov K Bech J Andersen H Kehlet (1999) ArticleTitleLevobupivacaine vs bupivacaine as infiltration anesthesia in inguinal herniorrhaphy. Br J Anaesth 82 280–282 Occurrence Handle1:CAS:528:DyaK1MXhvFGgtbs%3D Occurrence Handle10365010

    CAS  PubMed  Google Scholar 

  3. T Bisgaard B Klarskov K Bjerregaard et al. (1999) ArticleTitleMulti-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, double-blind, placebo-controlled study. Anesth Analg 89 1017–1024 Occurrence Handle1:STN:280:DyaK1MvktVygtg%3D%3D Occurrence Handle10512282

    CAS  PubMed  Google Scholar 

  4. A Goldstein P Grimault A Henique M Keller A Fortin E Darai (2000) ArticleTitlePreventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg 91 403–407 Occurrence Handle1:CAS:528:DC%2BD3cXlvVOqsrk%3D Occurrence Handle10910857

    CAS  PubMed  Google Scholar 

  5. RW Gristwood (2002) ArticleTitleCardiac and CNS toxicity of levobupivacaine: strengths of evidence for advantage over bupivacaine. Drug Saf 25 153–163 Occurrence Handle1:CAS:528:DC%2BD38Xkt1Sgur0%3D Occurrence Handle11945112

    CAS  PubMed  Google Scholar 

  6. B Johansson B Hallerback A Stubberod T Janbu B Edwin H Glise JH Solhaug (1997) ArticleTitlePreoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair: a randomised controlled trial. Eur J Surg 163 371–378 Occurrence Handle1:STN:280:ByiA3sfmtFU%3D Occurrence Handle9195171

    CAS  PubMed  Google Scholar 

  7. JA Katz PO Bridenbaugh DC Knarr SH Helton DD Denson (1990) ArticleTitlePharmacodynamics and pharmacokinetics of epidural ropivacaine in humans. Anesth Analg 70 16–21 Occurrence Handle1:STN:280:By%2BC38%2FgvVA%3D Occurrence Handle2297100

    CAS  PubMed  Google Scholar 

  8. T Labaille JX Mazoit X Paqueron D Franco D Benhamou (2002) ArticleTitleThe clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 94 100–105 Occurrence Handle1:CAS:528:DC%2BD38Xmt1GitA%3D%3D Occurrence Handle11772809

    CAS  PubMed  Google Scholar 

  9. DL Lewis WAL Thompson (1953) ArticleTitleReduction of postoperative pain. BMJ 1 973–974 Occurrence Handle13032582

    PubMed  Google Scholar 

  10. U Maestroni D Sortini C Devito et al. (2002) ArticleTitleA new method of preemptive analgesia in laparoscopic cholecystectomy. Surg Endosc 16 1336–1340 Occurrence Handle1:STN:280:DC%2BD38vntlGquw%3D%3D Occurrence Handle11988800

    CAS  PubMed  Google Scholar 

  11. O Mjåland J Ræder V Aasboe et al. (1997) ArticleTitleOutpatient laparoscopic cholecystectomy. Br J Surg 84 958–961 Occurrence Handle9240135

    PubMed  Google Scholar 

  12. B Papaziogas H Argiriadou P Papagiannopoulou T Pavlidis M Georgiou E Sfyra T Papaziogas (2001) ArticleTitlePreincisional intravenous low-dose ketamine and local infiltration with ropivacaine reduces postoperative pain after laparoscopic cholecystectomy. Surg Endosc 15 1030–1033 Occurrence Handle1:STN:280:DC%2BD3MrlvVCmsQ%3D%3D Occurrence Handle11443472

    CAS  PubMed  Google Scholar 

  13. N Pettersson BM Emanuelsson M Pharm H Reventlid R Hahn (1998) ArticleTitleHigh-dose ropivacaine wound infiltration for pain relief after inguinal hernia repair. Reg Anesth Pain Med 23 189–196 Occurrence Handle1:CAS:528:DyaK1cXislCjs7o%3D Occurrence Handle9570609

    CAS  PubMed  Google Scholar 

  14. AM Sarac AO Aktan N Baykan C Yegen R Yalin (1996) ArticleTitleThe effect and timing of local anesthesia in laparoscopic cholecystectomy. Surg Laparosc Endosc 6 362–366 Occurrence Handle10.1097/00019509-199610000-00005 Occurrence Handle1:STN:280:ByiD2crjs1E%3D Occurrence Handle8890420

    Article  CAS  PubMed  Google Scholar 

  15. DB Scott A Lee D Fagan GMR Bowler P Bloomfield R Lundh (1989) ArticleTitleAcute toxicity of ropivacaine compared with that of bupivacaine. Anaesth Analg 69 563–569 Occurrence Handle1:CAS:528:DyaK3MXhsFOjs7o%3D

    CAS  Google Scholar 

  16. K Slim (2000) ArticleTitlePain after laparoscopic cholecystectomy. Br J Surg 87 1249 Occurrence Handle1:STN:280:DC%2BD3M%2Fjs1OrtQ%3D%3D

    CAS  Google Scholar 

  17. BM Ure H Troidl W Spangenberger E Neugebauer R Lefering K Ullmann J Bende (1993) ArticleTitlePreincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy: a double-blind randomized clinical trial. Surg Endosc 7 482–488 Occurrence Handle1:STN:280:ByuD1MfksFE%3D Occurrence Handle8272992

    CAS  PubMed  Google Scholar 

  18. BM Ure H Troidl W Spangenberger A Dietrich R Lefering E Neugebauer (1994) ArticleTitlePain after laparoscopic cholecystectomy: intensity and localization of pain and analysis of predictors in preoperative symptoms and intraoperative events. Surg Endosc 8 90–96 Occurrence Handle1:STN:280:ByuB3MfnsVQ%3D Occurrence Handle8165491

    CAS  PubMed  Google Scholar 

  19. C Woolf WS Chong (1993) ArticleTitlePreemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 77 362–379 Occurrence Handle1:STN:280:ByyA2cfps1Y%3D Occurrence Handle8346839

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Ethnikis Aminis 41, 546 35 Thessaloniki, Greece

    P. Papagiannopoulou, H. Argiriadou, M. Georgiou, E. Sfyra & F. Kanakoudis

  2. Second Surgical Clinic, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Ethnikis Aminis 41, 546 35 Thessaloniki, Greece

    B. Papaziogas

Authors
  1. P. Papagiannopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Argiriadou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Georgiou
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Papaziogas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Sfyra
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Kanakoudis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Papaziogas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Papagiannopoulou, P., Argiriadou, H., Georgiou, M. et al. Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy . Surg Endosc 17, 1961–1964 (2003). https://doi.org/10.1007/s00464-002-9256-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-002-9256-1

Keywords

Search

Navigation