Obesity Surgery

, 18:1581 | Cite as

Continuous Infusion of Intraperitoneal Bupivacaine after Laparoscopic Surgery: A Randomized Controlled Trial

  • Danny A. Sherwinter
  • Amir M. Ghaznavi
  • David Spinner
  • Richard H. Savel
  • Jerzy M. Macura
  • Harry Adler
Research Article

Abstract

Background

A standard approach for postoperative analgesia in laparoscopic surgery is to infiltrate the incisions with local anesthetic in combination with systemic opioids. The intraperitoneal introduction of local anesthetic in this setting has the potential to provide appropriate analgesia without the side effects of systemic opioids. We performed a randomized clinical trial of the On-Q pump delivery system to determine the safety and efficacy of this device for this novel purpose.

Methods

Thirty patients undergoing laparoscopic adjustable gastric banding were randomly assigned to one of two groups. The treatment group received On-Q pump systems filled with 0.375% bupivacaine, while the control group received pumps filled with 0.9% normal saline. The pump’s catheter was introduced intraperitoneally, and bupivacaine or saline was then delivered for the first 48 h after surgery. Patient’s subjective pain scores were evaluated at preset intervals. In addition, shoulder pain, morphine requirements, and anti-emetic requirements were tabulated.

Results

A statistically significant decrease in patient’s subjective reports of pain by visual analog score was noted in the On-Q group 1.8 ± 1.93 vs. control 3.5 ± 2.4, p < 0.046 and remained significant until the end of the study (48 h). No statistical difference was noted in shoulder pain, morphine requirements, or anti-emetic requirements at any time point.

Conclusion

Our trial was able to provide evidence of significant reduction in postoperative pain as measured by subjective pain scores with the use of continuous intraperitoneal bupivacaine using the On-Q pain pump system. Further investigation is warranted to evaluate the cost effectiveness of this technique.

Keywords

Intraperitoneal bupivacaine Laparoscopic surgery On-Q pump Bariatric surgery Laparoscopic adjustable gastric banding Morbid obesity Postoperative pain 

References

  1. 1.
    Dahl JB, Moiniche S, Kehlet H. Wound infiltration with local anaesthetics for postoperative pain relief. Acta Anaesthsiol Scand 1994;38:7–14.CrossRefGoogle Scholar
  2. 2.
    Moiniche S, Mikkelsen S, Wetterslev J, Dahl JB. A qualitative systemic review of incisional local anaesthesia for postoperative pain relief after abdominal surgery. Br J Anaesth 1998;81:377–83.PubMedGoogle Scholar
  3. 3.
    Ure BM, Troidl H, Spangenberger W, et al. Pain after laparoscopic cholecystectomy. Surg Endosc 1994;8:90–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Wallin G, Cassuto J, Högström S, Hedner T. Influence of intraperitoneal anesthesia on pain and the sympathoadrenal response to abdominal surgery. Acta Anaesthesiol Scand 1988;32(7):553–8.PubMedGoogle Scholar
  5. 5.
    Elfberg BA, Sjövall-Mjöberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech 2000;10(6):357–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Keita H, Benifla JL, Le Bouar V, Porcher R, Wachowska B, Bedairia K, Mantz J, Desmonts JM. Prophylactic ip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery. Can J Anaesth 2003;50(4):362–7.PubMedGoogle Scholar
  7. 7.
    Mraović B, Jurisić T, Kogler-Majeric V, Sustic A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997;41(2):193–6.PubMedGoogle Scholar
  8. 8.
    Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996;10(1):44–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Symons JL, Kemmeter PR, Davis AT, Foote JA, Baker RS, Bettendorf MJ, Paulson JE. A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparos copic Roux-en-Y gastric bypass. J Am Coll Surg 2007;204(3):392–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta A, Thörn SE, Axelsson K, Larsson LG, Agren G, Holmström B, Rawal N. Postoperative pain relief using intermittent injections of 0.5% ropivacaine through a catheter after laparoscopic cholecystectomy. Anesth Analg 2002;95(2):450–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Ozer Y, Tanriverdi HA, Ozkocak I, Altunkaya H, Demirel CB, Bayar U, Barut A. Evaluation of a local anaesthesia regimen using a subphrenic catheter after gynaecological laparoscopy. Eur J Anaesthesiol 2005;22(6):442–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Alkhamesi NA, Peck DH, Lomax D, Darzi AW. Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blinded clinical trial. Surg Endosc 2007;21(4):602–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Liu SS, Richman JM, Thirlby RC, Wu CL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. JACS 2006;203:6.Google Scholar
  14. 14.
    Ren CJ, Fielding GA. Laparoscopic adjustable gastric banding: surgical technique. J Laparoendosc Adv Surg Tech 2003;13(4):257–63.CrossRefGoogle Scholar
  15. 15.
    Geiss AC, Katz L. The use of a stabilizing mesh platform and ultrasound adjustment of the Lap Band. Plenary session presentation. ASBS nineteenth annual meeting. 2003.Google Scholar
  16. 16.
    Savel RH, Balasubramanya S, Lasheen S, Gaprindashvili T, Arabov E, Fazylov RM, Lazzaro RS, Macura JM. Beneficial effects of humidified, warmed carbon dioxide insufflation during laparoscopic bariatric surgery: a randomized clinical trial. Obes Surg 2005;15(1):64–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996;10:44–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Jiranantarat V, Rushatamukayanunt W, Lert-akyamanee N, et al. Analgesic effect of intraperitoneal instillation of bupivacaine for postoperative laparoscopic cholecystectomy. J Med Assoc Thai 2002;85(Suppl 3):S897–903.PubMedGoogle Scholar
  19. 19.
    Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995;81:379–84.PubMedCrossRefGoogle Scholar
  20. 20.
    Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N. A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder-tip pain following laparoscopy. Am J Surg 1998;176:258–61.PubMedCrossRefGoogle Scholar
  21. 21.
    Tsimoyiannis EC, Siakis P, Tassis A, Lekkas ET, Tzourou H, Kambili M. Intraperitoneal normal saline infusion for postoperative pain after laparoscopic cholecystectomy. World J Surg 1998;22:824–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Pasqualucci A, de Angelis V, Contardo R, Colò F, Terrosu G, Donini A, Pasetto A, Bresadola F. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology 1996;85(1):11–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Danny A. Sherwinter
    • 1
    • 2
  • Amir M. Ghaznavi
    • 1
  • David Spinner
    • 1
  • Richard H. Savel
    • 1
  • Jerzy M. Macura
    • 1
  • Harry Adler
    • 1
  1. 1.Department of Minimally Invasive SurgeryMaimonides Medical CenterBrooklynUSA
  2. 2.Department of SurgeryMaimonides Medical CenterBrooklynUSA

Personalised recommendations