Advertisement

Obesity Surgery

, Volume 29, Issue 6, pp 1735–1741 | Cite as

Efficacy of Intraperitoneal Instillation of Bupivacaine after Bariatric Surgery: Randomized Controlled Trial

  • Islam OmarEmail author
  • Abdulmenem Abualsel
Original Contributions

Abstract

Introduction

Obesity is one of the greatest health problems. Bariatric surgery is more effective than non-surgical options; however, postoperative pain is bound to a greater morbidity. Control of postoperative pain is important in facilitating patient convalescence. In this study, we assessed the efficacy of intraperitoneal instillation of bupivacaine after bariatric surgery.

Methods

A hundred patients who underwent bariatric procedures including sleeve gastrectomy, sleeve gastrectomy with cardioplasty, gastric bypass, and gastric mini bypass (one anastomosis gastric bypass) were included in the study. Patients were divided into two groups randomly, 50 patients for each; group I had intraperitoneal instillation of 40 ml bupivacaine 0.25% at the end of the procedure, while group II had normal saline instillation. Monitoring of pain control in the first 24 h after surgery was done using the visual analogue scale (VAS) to assess the efficacy of intraperitoneal bupivacaine instillation and its effect on the overall opioid usage, postoperative nausea and vomiting (PONV), and shoulder tip pain.

Results

Pain scores were significantly lower in group I compared to group II at recovery, 2, 4 and 6 h after surgery, P = 0.004, 0.001, < 0.001, and 0.001 respectively. However, there were no significant differences between 12 and 24 h postoperatively. Additionally, there was a significant difference regarding the need for rescue analgesia at recovery P = < 0.001*. Further analysis revealed lower morphine consumption via PCA in group I compared to group II P = 0.013*. There were no significant differences with the use of intraperitoneal bupivacaine as regards nausea, vomiting, or shoulder tip pain, P = 0.688, 0.249, and 0.487, respectively.

Conclusions

Intraperitoneal instillation of bupivacaine provides a good analgesia in the early postoperative period, reduces the overall consumption of opioid, and decreases the rescue analgesia requirement in the first 24 h after surgery.

Keywords

Intraperitoneal instillation of bupivacaine Bariatric surgery Sleeve gastrectomy Gastric bypass Mini gastric bypass Local anesthetic instillation IPLAI Postoperative analgesia 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

Approved by the ethical committee.

Consent

Written informed consent was obtained from the patient for participation in the study before allocation to either arms of the study, in addition to publishing the results.

References

  1. 1.
    Malik VS, Willett WC, Hu FB. Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2013;9:13–27.CrossRefGoogle Scholar
  2. 2.
    Yan LL, Daviglus ML, Liu K, et al. Midlife body mass index and hospitalization and mortality in older age. JAMA. 2006;295:190–8.CrossRefGoogle Scholar
  3. 3.
    Vlad I. Obesity costs UK economy 2bn pounds sterling a year. BMJ. 2003;327:1308.CrossRefGoogle Scholar
  4. 4.
    Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357:741–52.CrossRefGoogle Scholar
  5. 5.
    Zhou X, Yu J, Li L, et al. Effects of bariatric surgery on mortality, cardiovascular events, and cancer outcomes in obese patients: systematic review and meta-analysis. Obes Surg. 2016 Nov;26(11):2590–601.  https://doi.org/10.1007/s11695-016-2144-x.CrossRefPubMedGoogle Scholar
  6. 6.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357:753–61.CrossRefGoogle Scholar
  7. 7.
    Babu R, Jain P, Sherif L. Intraperitoneal instillation: ropivacaine vs bupivacaine for post operative pain relief in laparoscopic cholecystectomy. Int J Health Sci Res. 2013;3(12):42–7.Google Scholar
  8. 8.
    Rawal N, Allvin R, Amilon A. Postoperative analgesia at home after ambulatory hand surgery: a controlled comparison of tramadol, metamizole and paracetamol. Anesth Analg. 2001;92:347–51.CrossRefGoogle Scholar
  9. 9.
    Egan TD. Miller’s anesthesia. 6th ed. Anesthesiology 2005;103(3):673.CrossRefGoogle Scholar
  10. 10.
    Bisgaard T, Klarskov B, Rosenberg J, et al. Characteristics and prediction of early pain after laparoscopic cholecystectomy. Pain. 2001;90(3):261–9.CrossRefGoogle Scholar
  11. 11.
    Kandil TS, El Hefnawy E. Shoulder pain following laparoscopic cholecystectomy: factors affecting the incidence and severity. J Laparoendosc Adv Surg Tech A. 2010;20(8):677–82.CrossRefGoogle Scholar
  12. 12.
    Tolver MA, Strandfelt P, Rosenberg J, et al. Pain characteristics after laparoscopic inguinal hernia repair. Surg Endosc. 2011;25(12):3859–64.CrossRefGoogle Scholar
  13. 13.
    Bisgaard T, Stockel M, Klarskov B, et al. Prospective analysis of convalescence and early pain after uncomplicated laparoscopic fundoplication. Br J Surg. 2004;91(11):1473–8.CrossRefGoogle Scholar
  14. 14.
    American Society of Hospital Pharmacists, Committee on Pharmacy and Pharmaceuticals. American hospital formulary service; a collection of drug monographs and other information. Hamilton: Hamilton Press; 1996.Google Scholar
  15. 15.
    Fernandez AZ, Demaria EJ, Tichansky DS, et al. Multivariate analysis of risk factors for death following gastric bypass for treatment of morbid obesity. Ann Surg. 2004;239:698–703.CrossRefGoogle Scholar
  16. 16.
    Huang S, Mi S, He Y, et al. Analgesic efficacy of trocar sites local anaesthetic infiltration with and without transversus abdominis plane block after laparoscopic hysterectomy: a randomized trial. Int J Clin Exp Med. 2016;9(3):6518–24.Google Scholar
  17. 17.
    Yadava A, Rajput SK, Katiyar S, et al. A comparison of intraperitoneal bupivacaine – tramadol with bupivacaine – magnesium sulphate for pain relief after laparoscopic cholecystectomy: prospective, randomised study. Indian J Anaesth. 2016;60(10):757–62.CrossRefGoogle Scholar
  18. 18.
    Badawy AM. Intraperitoneal analgesia to reduce pain after laparoscopic hysterectomy. Int J Reprod Contracept Obstet Gynecol. 2017;6:3235–40.CrossRefGoogle Scholar
  19. 19.
    Kim AJ, Yong RJ, Urman RD. The role of transversus abdominis plane blocks in ERAS pathways for open and laparoscopic colorectal surgery. J Laparoendosc Adv Surg Tech A. 2017 Published online 2017 Jul 25;27:909–14.  https://doi.org/10.1089/lap.2017.0337.CrossRefPubMedGoogle Scholar
  20. 20.
    Oh TK, Lee SJ, Do SH, et al. Transversus abdominis plane block using a short-acting local anaesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis. Surg Endosc. 2018;32(2):545–52.CrossRefGoogle Scholar
  21. 21.
    Hamill JK, Rahiri JL, Hill AG. Analgesic effect of intraperitoneal local anaesthetic in surgery: an overview of systematic reviews. J Surg Res. 2017;212:167–77.  https://doi.org/10.1016/j.jss.2017.01.022.CrossRefPubMedGoogle Scholar
  22. 22.
    Scarth E, Smith S. Drugs in anaesthesia and intensive care. 5th ed. Oxford University Press; 2016.  https://doi.org/10.1093/med/9780198768814.001.0001.
  23. 23.
    Malhotra N, Chanana C, Roy KK, et al. To compare the efficacy of two doses of intraperitoneal bupivacaine for pain relief after operative laparoscopy in gynaecology. Arch Gynecol Obstet. 2007;276(4):323–6.CrossRefGoogle Scholar
  24. 24.
    Mitra S, Khandelwal P, Roberts K, et al. Pain relief in laparoscopic cholecystectomy--a review of the current options. Pain Pract. 2012;12(6):485–96.CrossRefGoogle Scholar
  25. 25.
    Kahokehr A, Sammour T, Srinivasa S, et al. Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg. 2011;98(1):29–36.CrossRefGoogle Scholar
  26. 26.
    Marks JL, Ata B, Tulandi T. Systematic review and meta-analysis of intraperitoneal instillation of local anaesthetics for reduction of pain after gynecologic laparoscopy. J Minim Invasive Gynecol. 2012;19(5):545–53.CrossRefGoogle Scholar
  27. 27.
    Ruiz-Tovar J, Gonzalez J, Garcia A, et al. Intraperitoneal Ropivacaine irrigation in patients undergoing bariatric surgery: a prospective randomized clinical trial. Obes Surg. 2016 Nov;26(11):2616–21.CrossRefGoogle Scholar
  28. 28.
    Cohen AR, Smith AN, Henriksen BS. Postoperative opioid requirements following Roux-en-Y gastric bypass in patients receiving continuous bupivacaine through a pump system: a retrospective review. Hosp Pharm. 2013;48(6):479–83.CrossRefGoogle Scholar
  29. 29.
    Bindra TK, Chawla D, Kumar P, et al. Comparison of intraperitoneal instillation of ropivacaine with normal saline in laparoscopic cholecystectomy. Int J Res Med Sci. 2017;5:4924–8.CrossRefGoogle Scholar
  30. 30.
    Choi GJ, Kang H, Baek CW, et al. Effect of intraperitoneal local anaesthetic on pain characteristics after laparoscopic cholecystectomy. World J Gastroenterol. 2015;21(47):13386–95.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bariatric Surgery UnitKing Hamad University HospitalAl SayhKingdom of Bahrain

Personalised recommendations