Effect of Trocar Site Bupivacaine Administration, Time of First Passage of Flatus, and Duration of the Surgery on Postoperative Pain After Sleeve Gastrectomy: a Case Control Study
- 138 Downloads
The effect of local anesthetic applications to trocar sites on postoperative pain control has been studied many times, and different results have been obtained. We planned a controlled study evaluating the effect of bupivacaine administration and other contributing factors on postoperative pain following sleeve gastrectomy.
Material and Methods
Patients who underwent laparoscopic sleeve gastrectomy were included in the study. Patients were randomized into two groups according to local application as either a local or non-local group. Also, the patients were grouped separately from local group allocation according to time to first passage of flatus (< 12 h, ≥ 12 h) and duration of surgery (> 50 min, ≤ 50 min). A visual analogue scale (VAS) was performed at 4, 8, 12, 24, and 48 h postoperatively. Opioid analgesics (pethidine HCl) were administered if the patient’s VAS score was greater than 5. Demographic characteristics, such as age, gender, height, weight, body mass index (BMI), and operative time, were recorded. Demographic characteristics and VAS scores were compared between groups.
A total of 168 patients were included in the study. Of these, 84 patients were included in both of the local and non-local groups. The demographic characteristics between groups were similar. There was no significant difference between groups in terms of VAS scores (p > 0.05). In the analysis according to the time to first passage of flatus, the 48th-hour VAS scores were lower in the early flatus group (p = 0.036). According to the duration of surgery, first flatus was detected earlier, and VAS scores at the 8th and 12th hours were less in the short operation group (p < 0.001, p = 0.005, p = 0.031, respectively).
Although we did not show any effect of local administration of bupivacaine in LSG on pain, we concluded that other factors like duration of surgery and first flatus time have an impact on this issue.
KeywordsPostoperative pain Trocar site bupivacaine First passage of flatus
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethics committee approval was obtained for this study.
Informed consent was obtained from the patients.
- 1.Torres-Landa S, Kannan U, Guajardo I, Pickett-Blakely OE, Dempsey DT, Williams NN, Dumon KR. The surgical management of obesity. Minerva Chir. 2017 Dec 14. doi: https://doi.org/10.23736/S0026-4733.17.07588-5. [Epub ahead of print]
- 3.El Sherif FA, Othman AH, Abd El-Rahman AM, et al. Effect of adding intrathecal morphine to a multimodal analgesic regimen for postoperative pain management after laparoscopic bariatric surgery: a prospective, double-blind, randomized controlled trial. Br J Pain. 2016;10(4):209–16. https://doi.org/10.1177/2049463716668904.CrossRefGoogle Scholar
- 5.Tam T, Harkins G, Wegrzyniak L, et al. Infiltration of bupivacaine local anesthetic to trocar insertion sites after laparoscopy: a randomized, double-blind, stratified, and controlled trial. J Minim Invasive Gynecol. 2014;21(6):1015–21. https://doi.org/10.1016/j.jmig.2014.04.013. Epub 2014 May 2CrossRefGoogle Scholar
- 8.El Hachem L, Small E, Chung P, Moshier EL, Friedman K, Fenske SS, Gretz HF 3rd. Randomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy. Am J Obstet Gynecol. 2015 212(2):182.e1–9. doi: https://doi.org/10.1016/j.ajog.2014.07.049.
- 10.Cantore F, Boni L, Di Giuseppe M, et al. Pre-incision local infiltration with levobupivacaine reduces pain and analgesic consumption after laparoscopic cholecystectomy: a new device for day-case procedure. Int J Surg. 2008;6(Suppl 1):S89–92. https://doi.org/10.1016/j.ijsu.2008.12.033. Epub 2008 Dec 24CrossRefGoogle Scholar
- 16.Ruiz-Tovar J, Muñoz JL, Gonzalez J, et al. Postoperative pain after laparoscopic sleeve gastrectomy: comparison of three analgesic schemes (isolated intravenous analgesia, epidural analgesia associated with intravenous analgesia and port-sites infiltration with bupivacaine associated with intravenous analgesia). Surg Endosc. 2017;31(1):231–6. https://doi.org/10.1007/s00464-016-4961-3.CrossRefGoogle Scholar
- 20.Cho JS, Kim HI, Lee KY, et al. Comparison of the effects of patient-controlled epidural and intravenous analgesia on postoperative bowel function after laparoscopic gastrectomy: a prospective randomized study. Surg Endosc. 2017;31(11):4688–96. https://doi.org/10.1007/s00464-017-5537-6.CrossRefGoogle Scholar