Abstract
Purpose
To determine the effectiveness ofip bupivacaine and/or morphine for postoperative analgesia after laparoscopic surgery. A controversy exists on the effectiveness and clinical value ofip injection of local anesthetics for postoperative analgesia. A possible peripheral analgesic effect of morphine afterip injection remains debated as well.
Methods
We conducted a randomized, double-blinded, study to compare the efficacy of prophylacticip administration of 0.9% saline (n = 16), 0.5% bupivacaine (100 mg,n = 15), morphine (3 mg,n = 16) and a mixture with 0.5% bupivacaine (100 mg) and morphine (3 mg,n = 18) to reduce both postoperative pain scores and analgesic requirements after gynecologic laparoscopic surgery. A multimodal analgesia regimen (acetaminophen, nonsteroidal antiinflammatory drugs and morphine) was used for postoperative analgesia.
Results
No difference was observed in postoperative pain scores (visual analogue scale at rest and on coughing), or analgesic requirements during the first 24 postoperative hours between the four groups. There was also no significant intergroup difference in sedation scores and incidence of nausea and vomiting.
Conclusion
When multimodal postoperative analgesia is used, prophylacticip administration of 100 mg bupivacaine and/or 3 mg morphine does not significantly improve postoperative analgesia in patients undergoing laparoscopic gynecologic surgery.
Résumé
Objectif
Déterminer l’efficacité de l’administration intrapéritonéale ip de bupivacaïne et/ou de morphine pour l’analgésie postopératoire en chirurgie laparoscopique. L’efficacité et la valeur clinique de l’injection ip d’anesthésiques locaux pour l’analgésie postopératoire, de même que l’effet analgésique périphérique possible de la morphine après l’injection ip, demeurent discutables.
Méthode
Létude, randomisée et à double insu, voulait comparer l’efficacité de l’administration ip prophylactique de solution saline à 0,9 %(n= 16), de 100 mg de bupivacaine à 0,5 % (n = 15), de 3 mg de morphine (n = 16) et d’un mélange de 100 mg de bupivacaine à 0,5 % et de 3 mg de morphine (n = 18) pour réduire la douleur postopératoire et les besoins analgésiques à la suite d’une intervention gynécologique laparoscopique. Une analgésie multimodale (acétaminophène, anti-inflammatoires non stéroïdiens et morphine) a été utilisée pour l’analgésie postopératoire.
Résultats
Aucune différence intergroupe n’a été observée quant aux scores de douleur postopératoire (échelle visuelle analogique au repos et pendant la toux) ou aux besoins analgésiques pendant les 24 premières heures postopératoires. Les scores de sédation et l’incidence de nausées et de vomissements n’ont pas présenté non plus de différence intergroupe.
Conclusion
Quand on utilise une analgésie postopératoire multimodale, l’administration prophylactique ip de 100 mg de bupivacaine et/ou de 3 mg de morphine n’améliore pas signifcativement l’analgésie postopératoire en chirurgie gynécologique laparoscopique.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Schulze S, Thorup J. Pulmonary function, pain and fatigue after laparoscopic cholecystectomy. Eur J Surg 1993; 159: 361–4.
Soper NJ, Barteau JA, Dayman RV, Ashley SW, Dunnegan DL. Comparison of early postoperative results for laparoscopic versus standard open cholecystectomy. Surg Gynecol Obstet 1992; 174: 114–8.
Wiesel S, Grillas R. Patient-controlled analgesia after laparoscopic and open cholecystectomy. Can J Anaesth 1995; 42: 37–40.
Joris J, Cigarini I, Legrand M, et al. Metabolic and respiratory changes after cholecystectomy performed via laparotomy or laparoscopy. Br J Anaesth 1992; 69: 341–5.
Moiniche S, Jorgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90: 899–912.
Callesen T, Hjort D, Mogensen T, et al. Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth 1999; 82: 586–90.
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 Analg 2000; 91: 403–7.
Helvacioglu A, Weis R. Operative laparoscopy and postoperative pain relief. Fertil Steril 1992; 57: 548–52.
Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet 1991; 338: 1569–70.
Picard PR, Tramer MR, McQuay HJ, Moore RA. Analgesic efficacy of peripheral opioids (all except intra-articular): a qualitative systematic review of randomised controlled trials. Pain 1997; 72: 309–18.
Schulte-Steinberg H, Weninger E, Jokisch D, et al. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology 1995; 82: 634–40.
Maitre PO, Vozeh S, Heykants J, Thomson DA, Stanski DR. Population pharmacokinetics of alfentanil: the average dose-plasma concentration relationship and interindividual variability in patients. Anesthesiology 1987; 66: 3–12.
Dahmani S, Dupont H, Mantz J, Desmonts JM, Keita H. Predictive factors of early morphine requirements in the post-anaesthesia care unit (PACU). Br J Anaesth 2001; 87: 385–9.
Kehlet H. Synergism between analgesics. Ann Med 1995; 27: 259–62.
Gupta A, Bodin L, Holmstrom B, Berggren L. A systematic review of the peripheral analgesic effects of intraarticular morphine. Anesth Analg 2001; 93: 761–70.
Nagasaka H, Awad H, Yaksh T. Peripheral and spinal actions of opioids in the blockade of the autonomic response evoked by compression of the inflamed knee joint. Anesthesiology 1996; 85: 808–16.
Kissin I. Preemptive analgesia. Anesthesiology 2000; 93: 1138–43.
Choinière M, Rittenhouse BE, Perreault S, et al. Efficacy and costs of patient-controlled analgesia versus regularly administered intramuscular opioid therapy. Anesthesiology 1998; 89: 1377–88.
Pasqualucci A, De Angelis V, Contardo R, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. Anesthesiology 1996; 85: 11–20.
Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 2002; 94: 100–5.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Keita, H., Benifla, J.L., Le Bouar, V. et al. Prophylacticip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery. Can J Anesth 50, 362–367 (2003). https://doi.org/10.1007/BF03021033
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03021033