Skip to main content
SpringerLink
Log in

Preincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy

A double-blind randomized clinical trial

  • Original Articles
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Summary

The aim of this study was to investigate whether local anesthesia of abdominal wall wounds prior to laparoscopic cholecystectomy leads to decreased pain beyond the immediate postoperative period and thus improves the comfort of the patient. In a randomized, double-blind study 50 patients scheduled for laparoscopic cholecystectomy were divided into two groups. In one group (n=25) the skin, subcutis, fascia, muscle, and preperitoneal space were infiltrated with 8 ml of bupivacaine 0.5% 5 min before each abdominal wall incision. The control group (n=25) received normal saline.

The intensity of pain was assessed by a 100-point visual analogue scale (VAS) at rest and during movement and by the consumption of analgesics. Analgesic therapy was provided by on-demand analgesia with piritramid intravenously for 24 h and continued by ibuprofen orally on request.

The mean intensity of pain at rest and during movement was lower but not statistically significant in patients who received bupivacaine compared to the control group up to the second postoperative day. The difference was between 4 and 9 VAS points and therefore of doubtful clinical relevance. Similar statistically nonsignificant results were found for the mean consumption of piritramid up to 16 h after the operation. Three patients (12%) in the bupivacaine group localized the most severe pain up to the second postoperative day to the right lower abdominal wall wound where the gallbladder had been extracted compared to 11 patients (44%) of the control group (P=0.012). These results indicate that bupivacaine was effective at the site where it was administered. However, preincisional local anesthesia of the abdominal wall wounds in laparoscopic cholecystectomy does not lead to a significant clinical benefit for the patient.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bailey RW, Zucker KA, Flowers JL, Scovill WA, Graham SM, Imbembo AL (1991) Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann Surg 213: 531–536

    Google Scholar 

  2. Christensen T, Bendix T, Kehlet H (1982) Fatigue and cardiorespiratory function following abdominal surgery. Br J Surg 69: 417–419

    Google Scholar 

  3. Davis A, Millar JM (1988) Postoperative pain: a comparison of laparoscopic sterilisation and diagnostic laparoscopy. Anaesthesia 43: 796–797

    Google Scholar 

  4. Edwards ND, Anaes FC, Barclay K, Catling SJ, Martin DG, Morgan RH (1991) Day case laparoscopy: a survey of postoperative pain and an assessment of the value of diclofenac. Anaesthesia 46: 1077–1080

    Google Scholar 

  5. Feinstein AR (1977) Clinical biostatistics. The Mosby Company, St Louis, pp 162–166

    Google Scholar 

  6. Fishburne JI, Omran KF, Hulka JF (1974) Laparoscopic tubal clip sterilization under local anaesthesia. Fertil Steril 25: 762–765

    Google Scholar 

  7. Huskisson EC (1974) Measurement of pain. Lancet II: 1127–1131

    Google Scholar 

  8. Jebeles JA, Reilly JS, Gutierrez JF, Bradley EL, Kissin I (1991) The effect of pre-incisional infiltration of tonsils with bupivacaine on the pain following tonsillectomy under general anaesthesia. Pain 47: 305–308

    Google Scholar 

  9. Larsen KE, Kaalund JH (1983) Laparoscopic sterilization with the Falope-ring. Peroperative and late complications, method safety and a randomized investigation of immediate postoperative abdominal pain. Ysta Obstet Gynecol Scand 62:125–130

    Google Scholar 

  10. Lehmann KA, Tenbuhs B, Hoeckle W (1986) Patient-controlled analgesia with piritramid for the treatment of postoperative pain. Acta Anaesth Belg 37:247–257

    Google Scholar 

  11. Lehmann KA (1990) Lokalanästhetika: Allgemeine Pharmakologie. In: Lehmann KA (ed) Der postoperative Schmerz. Springer, Berlin Heidelberg New York, London, pp 266–279

    Google Scholar 

  12. Levack ID, Holmes JD, Robertson GS (1986) Abdominal wound perfusion for the relief of postoperative pain. Br J Anaesth 58: 615–619

    Google Scholar 

  13. McKenzie R, Phitayakorn P, Uy NT, Tantisira B, Wadhwa RK, Vicinie AF (1986) Topical etidocaine during laparoscopic tubal occlusion for postoperative pain relief. Obstet Gynecol 67: 447–449

    Google Scholar 

  14. McSherry CK, Ferstenberg H, Calhoun F, Lahman E, Virshup M (1985) The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 202: 59–63

    Google Scholar 

  15. Moss G, Regal ME, Lichting L (1986) Reduction of postoperative pain, narcotics, and length of hospitalization. Surgery 90: 206–209

    Google Scholar 

  16. Nayman J (1979) Measurement and control of postoperative pain. Ann R Coll Surg Engl 61: 419–426

    Google Scholar 

  17. Neugebauer E, Troidl H, Spangenberger W, Dietrich A, Lefering R (1991) Conventional versus laparoscopic cholecystectomy and the randomized controlled trial. Br J Surg 78: 150–154

    Google Scholar 

  18. Patel JM, Lanzafame RJ, Williams JS, Mullen BV, Hinshaw JR (1983) The effect of incisional infiltration of bupivacaine hydrochloride upon pulmonary functions, atelectasis, and narcotic need following elective cholecystectomy. Surg Gynecol Obstet 57: 338–340

    Google Scholar 

  19. Peters JH, Ellison EC, Innes JT, Liss JL, Nichols KE, Lomano JM, Roby SR, Front ME, Carey LC (1991) Safety and efficacy of laparoscopic cholecystectomy. Ann Surg 213: 3–12

    Google Scholar 

  20. van Raay JJ, Roukema JA, Lenderink BW (1992) Intraoperative wound infiltration with bupivacaine in patients undergoing elective cholecystectomy. Arch Surg 127: 457–459

    Google Scholar 

  21. Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS (1991) Laparoscopic cholecystectomy. Ann Surg 213: 665–676

    Google Scholar 

  22. Thomas DFM, Lambert WG, Williams KL (1983) The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain? Ann Royal Coll Surg Engl 65: 226–229

    Google Scholar 

  23. Troidl H, Eypasch E, Al-Jaziri A, Spangenberger W, Dietrich A (1991) Laparoscopic cholecystectomy in view of medical technology assessment. Dig Surg 8: 108–113

    Google Scholar 

  24. Troidl H, Spangenberger W, Langen R, Al-Jaziri A, Eypasch E, Neugebauer E, Dietrich J (1992) Laparoscopic cholecystectomy: technical performance, safety, and patient benefits. Endoscopy 24: 252–261

    Google Scholar 

  25. Tverskoy M, Cozacov C, Ayache M, Bradley EL, Kissin I (1990) Postoperative pain after inguinal herniorrhaphy with different types of analgesia. Aesth Analg 70: 29–53

    Google Scholar 

  26. Ure BM, Troidl H, Spangenberger W, Lefering R, Dietrich A, Sommer H (1992) Routine endoscopy of the upper digestive tract: evaluation of the clinical benefit before laparoscopic cholecystectomy. Br J Surg 79: 1174–1177

    Google Scholar 

  27. Wall PD (1988) The prevention of postoperative pain. Pain 33: 289–290

    Google Scholar 

  28. Wallin G, Cassuto J, Högström S, Hedner T (1988) Influence of intraperitoneal anesthesia on pain and the sympathoadrenal response to abdominal surgery. Acta Anaesthesiol Scand 32: 553–558

    Google Scholar 

  29. Zieglgänsberger W (1986) Central control of nociception. In: Mountcastle VB, Bloom FE, Geiger SR (eds) Handbook of physiology. Williams & Wilkins, Baltimore, pp 581–645

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Clinic, University of Cologne, Ostmerheimerstrasse 200, D-5000, Köln 91, Federal Republic of Germany

    B. M. Ure, H. Troidl, W. Spangenberger, K. Ullmann & J. Bende

  2. Biochemical and Experimental Division, IInd Department of Surgery, University of Cologne, Ostmerheimerstrasse 200, D-5000, Köln 91, Federal Republic of Germany

    E. Neugebauer & R. Lefering

Authors
  1. B. M. Ure
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Troidl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Spangenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Neugebauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. R. Lefering
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Ullmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Bende
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ure, B.M., Troidl, H., Spangenberger, W. et al. Preincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy. Surg Endosc 7, 482–488 (1993). https://doi.org/10.1007/BF00316685

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00316685

Key words

Search

Navigation