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Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis

Surgical Endoscopy volume 24, pages 3167–3176 (2010)Cite this article

Abstract

Background

This study aimed to determine the effect of local anesthesia administered before laparoscopic surgery (preemptive anesthesia) on postoperative pain.

Methods

The authors searched Medline, EMBase, and the Cochrane Central Register of Controlled Trials, as well as reference lists of textbooks and relevant articles. They contacted experts in the field of anesthesia and laparoscopic surgery for randomized controlled trials comparing preemptive administration of local anesthesia at the incision site or intraperitoneally with postoperative anesthesia administration or placebo. Trials were systematically assessed for eligibility and validity, and data were extracted in duplicate. The data were pooled across studies using a random effects model.

Results

The 26 studies that met the inclusion criteria were included in the analysis. Preemptive incisional local anesthetic was superior to placebo in terms of visual analog pain scores (VAS) at 4 h (weighted mean difference [WMD], −9.49 mm; 95% confidence interval [CI], −15.50 to −3.48) and 24 h (WMD, −4.75 mm; 95%CI, −8.90 to 0.60). However, no difference was found between these measures and those for postoperative incision-site infiltration. Preemptive intraperitoneal local anesthetic was superior to placebo in terms of VAS at 4 h (WMD, 5.76 mm; 95%CI, −11.27 to −0.25), 8 h (WMD, −9.64 mm; 95%CI, −13.68 to −5.60), 12 h (WMD, −4.68 mm; 95%CI, −5.86 to −3.49), and 24 h (WMD, −5.57 mm; 95%CI, −8.35 to −2.79), and superior to postoperative anesthesia administration at 8 h (WMD, −7.42; 95%CI, −13.40 to −1.45), 12 h (WMD, −7.27 mm; 95%CI, −10.26 to −4.28), and 24 h (WMD, −7.95 mm; 95%CI, −12.33 to −3.56).

Conclusion

Preemptive administration of local anesthetic at the incision site reduces postoperative pain compared with placebo but achieves an analgesic effect similar to that of postincisional anesthetic infiltration. Preemptive local anesthetic administered intraperitoneally decreases postoperative pain compared with both placebo and postoperative infiltration. Surgeons should use local analgesia in laparoscopic surgery to decrease postoperative pain, but the timing of administration is significant only for intraperitoneal infiltration.

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Disclosures

Shaun M. Coughlin, Paul J. Karanicolas, Heather M. A. Emmerton-Coughlin, Bilge Kanbur, Savas Kanbur, and Patrick H. D. Colquhoun have no conflicts of interest of financial ties to disclose.

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Affiliations

  1. Department of Surgery, University of Western Ontario, London, ON, Canada

    Shaun M. Coughlin, Heather M. A. Emmerton-Coughlin & Patrick H. D. Colquhoun

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Shaun M. Coughlin & Paul J. Karanicolas

  3. Department of Pharmacoeconomics, Ministry of Health, Ankara, Turkey

    Bilge Kanbur & Savas Kanbur

  4. University Hospital, London Health Sciences Centre, Room C8-114, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Shaun M. Coughlin

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  1. Shaun M. Coughlin
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Coughlin, S.M., Karanicolas, P.J., Emmerton-Coughlin, H.M.A. et al. Better late than never? Impact of local analgesia timing on postoperative pain in laparoscopic surgery: a systematic review and metaanalysis. Surg Endosc 24, 3167–3176 (2010). https://doi.org/10.1007/s00464-010-1111-1

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  • DOI: https://doi.org/10.1007/s00464-010-1111-1

Keywords

  • Laparoscopic surgery
  • Local anesthesia
  • Metaanalysis
  • Postoperative pain
  • Preemptive analgesia
  • Systematic review