Skip to main content
SpringerLink
Log in

Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study

  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background

This study aimed to evaluate the optimal timing of preemptive analgesia with bupivacaine peritoneal instillation in a prospective, randomized, double-blind, placebo-controlled trial.

Methods

In this study, 120 patients qualified for laparoscopic cholecystectomy were randomized to four groups. Group A received 2 mg/kg of bupivacaine in 200 ml of normal saline before creation of pneumoperitoneum. Group B received 2 mg/kg of bupivacaine in 200 ml of normal saline after creation of pneumoperitoneum. Group C received 200 ml of normal saline before creation of pneumoperitoneum. Group D received 200 ml of normal saline after creation of pneumoperitoneum. Local wound infiltration with bupivacaine was used before skin incisions. The primary end points of the study were postoperative pain intensity on a visual analog scale and incidence of shoulder tip pain. The secondary end points included the latency of nurse-controlled analgesia activation, the analgesia request rate, and analgesic consumption.

Results

Significantly lower visual analog scores were observed in group A versus groups C and B versus group D during the initial 48 and 24 h, respectively. The patients in group A versus group B reported significantly lower pain at 4 h (p < 0.001) and 8 h (p = 0.003) postoperatively, but the difference was not significant after 12, 24, and 48 h. None of the group A patients reported shoulder tip pain, whereas it was reported by 3 patients in group B, 6 patients in group C, and 7 patients in group D (p < 0.01). The latency of nurse-controlled analgesia activation was 426.8 ±57.2 min in group A, as compared with 307 ± 39.8 min in group B, 109.3 ± 51 min in group C, and 109 ± 46.5 min in group D (p < 0.001). A significantly lower analgesia request rate was observed in group A versus C, as compared with group B versus D, throughout the entire study period (p < 0.05).

Conclusions

Preemptive analgesia with bupivacaine peritoneal instillation is much more effective for pain relief if used before creation of pneumoperitoneum. Although the effect of bupivacaine peritoneal instillation is also noticeable when used after creation of pneumoperitoneum, it confers significantly lower benefits.

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

Fig. 1

Similar content being viewed by others

References

  1. Barczyński M, Herman RM (2003) A prospective randomized trial on comparison of low-pressure (LP) and standard-pressure (SP) pneumoperitoneum for laparoscopic cholecystectomy. Surg Endosc 17: 533–538

    Article  PubMed  Google Scholar 

  2. Barczyński M, Herman RM (2004) Low-pressure pneumoperitoneum combined with intraperitoneal saline washout for reduction of pain after laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc 18: 1368–1373

    Article  PubMed  Google Scholar 

  3. Bisgaard T, Klarskov B, Kehlet H, Rosenber J (2003) Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial. Ann Surg 238: 651–660

    Article  PubMed  Google Scholar 

  4. Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, Rosenber J (1999) Multiregional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multimodal analgesia: a randomized, double-blind, placebo-controlled study. Anesth Analg 89: 1017–1024

    Article  PubMed  CAS  Google Scholar 

  5. Cervini P, Smith LC, Urbach DR (2002) The effect of intraoperative bupivacaine administration on parenteral narcotic use after laparoscopic appendectomy. Surg Endosc 16: 1579–1582

    Article  PubMed  CAS  Google Scholar 

  6. Cunniffe MG, McAnena OJ, Dar MA, Calleary J, Flynn N (1998) A prospective randomized trial of intraoperative bupivacaine irrigation for management of shoulder tip pain following laparoscopy. Am J Surg 176: 258–261

    Article  PubMed  CAS  Google Scholar 

  7. Elfberg BA, Sjövall-Mjöberg S (2000) Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc 6: 357–359

    Article  Google Scholar 

  8. Elhakim M, Elkott M, Alin NM, Tahoun HM (2000) Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand 44: 280–284

    Article  PubMed  CAS  Google Scholar 

  9. Fletcher D, Kayser V, Guilbaud G (1996) Influence of timing of administration on the analgesic effect of bupivacaine infiltration in carrageenin-injected rats. Anaesthesiology 84: 1129–1137

    Article  CAS  Google Scholar 

  10. Gharaibeh KI, Al-Jaberi TM (2000) Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparoendosc Adv Surg Tech A 10: 137–141

    Article  PubMed  CAS  Google Scholar 

  11. Hernandez-Palazon J, Tortossa JA, Nuno de la Rosa V, Gimenez-Viudes J, Ramirez G, Robles R (2003) Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy. Eur J Anaestesiol 20: 891–896

    Article  CAS  Google Scholar 

  12. Maestroni U, Sarli D, Devito C, Pour Morard Kohan Brunaldi F, Anania G, Pavanelli L, Pasqualucci A, Donini A (2002) A new method of preemptive analgesia in laparoscopic cholecystectomy. Surg Endosc 16: 1336–1340

    Article  PubMed  CAS  Google Scholar 

  13. Mouton WG, Bessell JR, Otten KT, Maddern GJ (1999) Pain after laparoscopy. Surg Endosc 13: 445–448

    Article  CAS  PubMed  Google Scholar 

  14. Ng A, Smith G (2002) Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 89: 535–537

    Article  CAS  PubMed  Google Scholar 

  15. Ng A, Swami A, Smith G, Robertson G, Lloyd DM (2004) Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial. Eur J Anaesthesiol 21: 653–657

    Article  PubMed  CAS  Google Scholar 

  16. O’Hanlon DM, Colbert S, Ragheb J, McEntee GP, Chambers F, Moriarty DC (2002) Intraperitoneal pethidine versus intramuscular pethidine for the relief of pain after laparoscopic cholecystectomy: randomized trial. World J Surg 26: 1432–1436

    Article  PubMed  Google Scholar 

  17. Papagiannopoulou P, Argiriadou H, Georgius M, Papaziogas B, Sfyra E, Kanakoudis F (2003) Preincisional local infiltration of levobupivacaine vs ropivacaine for pain control after laparoscopic cholecystectomy. Surg Endosc 17: 1961–1964

    Article  CAS  PubMed  Google Scholar 

  18. Pascqualucci A, De Angelis V, Contardo R, Colo F, Terrosu G, Donini A, Pasetto A, Bresadola F (1996) Preemptive analgesia: A randomized, double-blind, placebo-controlled study. Anesthesiology 85: 11–20

    Article  Google Scholar 

  19. Scheinin B, Kellokumpu I, Lindgren L, Haglund C, Rosenberger PH (1995) Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 39: 195–198

    Article  PubMed  CAS  Google Scholar 

  20. Szem JW, Hydo L, Barie PS (1996) A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 10: 44–48

    Article  CAS  PubMed  Google Scholar 

  21. Tsimoyiannis EC, Glantzounis G, Lakkas ET, Siakas P, Jabarin M, Tzourou H (1998) Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 8: 416–420

    Article  CAS  PubMed  Google Scholar 

  22. Ure BM, Troidl H, Spangenberger W, Neugebauer E, Lefering R, Ullmann K, Bende J (1993) Preincisional local anesthesia with bupivacaine and pain after laparoscopic cholecystectomy: a double-blind randomized clinical trial. Surg Endosc 7: 482–488

    Article  PubMed  CAS  Google Scholar 

  23. Weber A, Munoz J, Garteiz D, Cueto J (1997) Use of subdiaphragmatic bupivacaine instillation to control postoperative pain after laparoscopic surgery. Surg Laparosc Endosc 7: 6–8

    Article  PubMed  CAS  Google Scholar 

  24. Wills VL, Hunt DR (2000) Pain after laparoscopic cholecystectomy. Br J Surg 87: 273–284

    Article  PubMed  CAS  Google Scholar 

  25. Wnęk W, Zajączkowska R, Wordliczek J, Dobrogowski J, Korbut R (2004) Influence of preoperative ketoprofen administration (preemptive analgesia) on analgesic requirement and the level of prostaglandins in the early postoperative period. Pol J Pharmacol 56: 547–552

    PubMed  Google Scholar 

  26. Woolf CJ, Mannion RJ (1999) Neuropathic pain: aethiology, symptoms, mechanisms, and management. Lancet 353: 1959–1964

    Article  CAS  PubMed  Google Scholar 

  27. Wordliczek J, Banach M, Garlicki J, Jakowicka-Wordliczek J, Dobrogowski J (2002) Influence of pre- or intraoperational use of tramadol (preemptive or preventive analgesia) on tramadol requirement in the early postoperative period. Pol J Pharmacol 54: 693–697

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General Surgery, Jagiellonian University College of Medicine, 37 Prądnicka Street, 31-202, Kraków, Poland

    M. Barczyński, A. Konturek & R. M. Herman

Authors
  1. M. Barczyński
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Konturek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. M. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Barczyński.

Additional information

The initial results were presented at the 12th International Congress of the European Association for Endoscopic Surgery (EAES), 9–12 June 2004, Barcelona, Spain, and awarded the Karl Storz EAES Prize. The final results were presented at the 13th International Congress of the European Association for Endoscopic Surgery (EAES), 1–4 June 2005, Venice, Italy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barczyński, M., Konturek, A. & Herman, R.M. Superiority of preemptive analgesia with intraperitoneal instillation of bupivacaine before rather than after the creation of pneumoperitoneum for laparoscopic cholecystectomy: a randomized, double-blind, placebo-controlled study. Surg Endosc 20, 1088–1093 (2006). https://doi.org/10.1007/s00464-005-0458-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-005-0458-1

Keywords

Search

Navigation