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INTRAPERITONEAL INSTILLATION OF BUPIVACAINE FOR ANALGESIA AFTER LAPAROSCOPIC STERILISATION: A CASE CONTROL STUDY.

ABSTRACT: Efficacy of intraperitoneal instillation of bupivacaine at the time of laparoscopic sterilisation to provide postoperative analgesia was studied. In 40 patients undergoing laparoscopic sterilisation 0.75ml/kg of 0.125% bupivacaine was instilled in the peritoneal cavity (Group-I) and another 40 patients where the topical anaesthetic was not used served as controls (Group-II). Pain scores on Visual Analog Scale (VAS) were studied 1,2,4,6 and 24 hours after surgery in both groups. Mean VAS score was significantly lower in Group-I, 1,2 and 4 hours after surgery (p<0.05). Rescue analgesia was required in 20% patients of Group-I compared to 52.5% in Group-II which is definitely significant (p<0.001). No complications or side effects were noted in the bupivacaine treated group. This simple technique provides excellent analgesia in the immediate postoperative period following laparoscopic sterilisation which will go a long way in enhancing patient satisfaction and motivating other eligible clients to come forward for laparoscopic sterilisation.

SUBMITTER: Goyal BK

PROVIDER: S-EPMC5531918 | biostudies-other | 1999 Oct

REPOSITORIES: biostudies-other

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Project description:ObjectiveSeveral modalities for analgesia after laparoscopic procedures have been used. This study aimed to investigate the efficacy of early versus late bupivacaine/tramadol combination and bupivacaine/dexmedetomidine combination in analgesia for laparoscopic cancer surgeries.MethodsA total of 100 patients of both genders scheduled for elective laparoscopic cancer surgeries were included. Patients were randomly assigned to one of four groups each comprises 25 patients. Group 1: early bupivacaine/tramadol, Group 2: late bupivacaine/tramadol, Group 3: early bupivacaine/dexmedetomidine, and Group 4: late bupivacaine/dexmedetomidine. Early groups received the intraperitoneal instillation before start of surgery and late groups received the instillation after completion of surgery. Perioperative heart rate (HR) and mean arterial blood pressure (MAP) were recorded. The degree of postoperative pain was measured at rest and with cough using Visual analogue scale (VAS) score at 2, 4, 6, 12, 18 and 24 h after surgery. In addition, the total intraoperative fentanyl and postoperative morphine doses were calculated.ResultsBoth late bupivacaine/tramadol, bupivacaine/dexmedetomidine groups had longer time to receive first analgesic requirement (13.4±3.9, 11.3±3.9 h) respectively as compared to early bupivacaine/tramadol, bupivacaine/dexmedetomidine groups (9.8± 3.6, 8.4± 2.8 h), respectively. Between each early and late group, intraoperative fentanyl consumption was higher for the late groups (75± 22.8, 73± 21.55µg) versus (32.7± 10.9, 37.5± 13.3 µg), respectively. As regards to rescue analgesic requirements, both early bupivacaine/tramadol and bupivacaine/dexmedetomidine groups consumed more analgesics (5.2± 2.0 and 6.1± 1.8 mg) as compared to the late groups (3.2± 0.8 and 4.3± 1.5 mg), respectively. The four groups were comparable for their perioperative HR and MAP values.ConclusionIntraperitoneal instillation of bupivacaine/tramadol and bupivacaine/dexmedetomidine could be considered an effective route for analgesic administration during laparoscopic cancer surgeries. Early instillation reduced the intraoperative opioid consumption and late instillation resulted in reduced postoperative opioid consumption.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04813016.

Project description:BackgroundTransversus abdominis plane (TAP) infiltration has been increasingly used for postsurgical analgesia in abdominal/pelvic procedures; however, duration/extent of analgesia with standard local anesthetics is limited. This pilot study assessed the preliminary efficacy and safety of two volumes of liposome bupivacaine administered via TAP infiltration in patients undergoing robotic laparoscopic prostatectomy.MethodsIn this single-center, open-label, prospective study, patients older than 18 years received TAP infiltration with liposome bupivacaine immediately after surgery. The first 12 patients received a total volume of 20 mL liposome bupivacaine (266 mg); the next 12 received 40 mL liposome bupivacaine (266 mg). The liposome bupivacaine was diluted with 0.9% normal saline. The primary efficacy measure was duration of analgesia, measured by time to first opioid administration. Secondary outcome measures included patient-assessed pain scores, opioid use, and opioid-related adverse events (AEs).ResultsTwenty-four patients received liposome bupivacaine (20 mL, n=12; 40 mL, n=12) and were included in the primary analysis. Three refused participation in a 10-day follow-up visit and did not complete the study. Median time to first opioid administration after surgery was 23 and 26 minutes for the 20 and 40 mL groups, respectively. Mean total amount of postsurgical opioids ranged from 25.4 to 27.3 mg; after hospital discharge to day 10, both groups required a mean of 0.7 oxycodone/acetaminophen tablets/day. Mean pain scores of 4.4 and 5.3 were reported at 1 hour and 3.1 and 3.9 at 2 hours postsurgery, with 20 and 40 mL doses, respectively. Neither group had mean scores higher than 3.0 at any further assessments. No opioid-related or treatment-related serious AEs were reported.ConclusionMedian time to first opioid administration did not differ between the two groups. No differences in secondary outcomes were observed on the basis of volume administered. These initial findings suggest further study of liposome bupivacaine administered via TAP infiltration as part of a multimodal analgesic regimen in laparoscopic robotic prostatectomy may be warranted.

Project description:The main goal of the present randomized clinical trial was to investigate the effects of subcutaneous administration of two different local anesthetics at trocar incision sites at the abdominal wall in combination with intraoperative intraperitoneal instillation of local anesthetics, on the character of postoperative pain, in adolescents who underwent laparoscopic varicocelectomy. A total of 60 patients with a median age of 16 years, who received laparoscopic varicocele repair, were included in this randomized clinical trial. The patients were randomly assigned to three study groups receiving 2% lidocaine, 0.5% levobupivacaine, or the control group. The Visual Analogue Scale (VAS) was used by a blinded nurse at four different time points (2, 6, 12 and 24 h after the surgery) to measure pain intensity. The significant effect of time on the pain intensity (p = 0.001) was found. Additionally, the interaction between time and different local analgesics (p < 0.001) was observed. In patients in whom 0.5% levobupivacaine has been used, significantly lower VAS pain scores were recorded at each time point assessed, in comparison with the patients who received 2% lidocaine or the patients from the control group in whom no local anesthetic was applied (p < 0.001). Furthermore, in patients in whom 2% lidocaine was administrated, significantly lower pain levels according to VAS were reported than in those from the control group, except for the time point at 24 h after surgery when pain levels were comparable. Concerning the postoperative pain control, the number of patients who requested oral analgesics postoperatively was significantly lower in the group of patients in whom local anesthetic was administrated intraoperatively (2% lidocaine-n = 4, 20%; 0.5% levobupivacaine-n = 1, 5%) compared to the patients who did not receive any local anesthetic during the surgery (n = 13; 65%) (p < 0.001). A significant reduction in postoperative pain intensity and analgesics consumption in patients undergoing laparoscopic varicocelectomy who received intraoperative local anesthetic was observed. The best effect on postoperative pain intensity, according to the VAS score, was achieved by 0.5% levobupivacaine.

Project description:BackgroundOpioid-based postsurgical analgesia exposes patients undergoing laparoscopic colectomy to elevated risk for gastrointestinal motility problems and other opioid-related adverse events (ORAEs). The purpose of our research was to investigate postsurgical outcomes, including opioid consumption, hospital length of stay, and ORAE risk associated with a multimodal analgesia regimen, employing a single administration of liposome bupivacaine as well as other analgesics that act by different mechanisms.MethodsWe analyzed combined results from 6 Phase IV, prospective, single-center studies in which patients undergoing laparoscopic colectomy received opioid-based intravenous patient-controlled analgesia (PCA) or multimodal analgesia incorporating intraoperative administration of liposome bupivacaine. As-needed rescue therapy was available to all patients. Primary outcome measures were postsurgical opioid consumption, hospital length of stay, and hospitalization costs. Secondary measures included time to first rescue opioid use, patient satisfaction with analgesia (assessed using a 5-point Likert scale), and ORAEs.ResultsEighty-two patients underwent laparoscopic colectomy and did not meet intraoperative exclusion criteria (PCA n = 56; multimodal analgesia n = 26). Compared with the PCA group, the multimodal analgesia group had significantly lower mean total postsurgical opioid consumption (96 vs 32 mg, respectively; P < 0.0001) and shorter median postsurgical hospital length of stay (3.0 vs 4.0 days; P = 0.0019). Geometric mean costs were $11,234 and $13,018 in the multimodal analgesia and PCA groups, respectively (P = 0.2612). Median time to first rescue opioid use was longer in the multimodal analgesia group versus PCA group (1.1 hours vs 0.6 hours, respectively; P=0.0003). ORAEs were experienced by 41% of patients receiving intravenous opioid PCA and 8% of patients receiving multimodal analgesia (P = 0.0019). Study limitations included use of an open-label, nonrandomized design; small population size; and the inability to isolate treatment-related effects specifically attributable to liposome bupivacaine.ConclusionsCompared with intravenous opioid PCA, a liposome bupivacaine-based multimodal analgesia regimen reduced postsurgical opioid use, hospital length of stay, and ORAEs, and may lead to improved postsurgical outcomes following laparoscopic colectomy.

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INTRAPERITONEAL INSTILLATION OF BUPIVACAINE FOR ANALGESIA AFTER LAPAROSCOPIC STERILISATION: A CASE CONTROL STUDY.

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