RESUMEN
BACKGROUND: Intraperitoneal local anesthetic (IPLA) reduces postoperative pain as shown by previous systematic reviews. The purpose of this review was to compare the efficacy of IPLA between different types of procedure and to formulate GRADE recommendations for the use of IPLA. MATERIALS AND METHODS: A systematic search for systematic reviews of the effect of IPLA, versus no IPLA or placebo, on pain after any surgical procedure. Databases included in the study were MEDLINE, EMBASE, CDSR, and DARE. Two reviewers independently undertook searches, selected studies, extracted data, and assessed the risk of bias. Meta-analysis was by random effects. Recommendation was by GRADE. The main outcome measure was self-reported early postoperative pain scores. RESULTS: Searches uncovered nine systematic reviews. This study included randomized trials numbered 76, representing 4000 participants, 2022 in IPLA and 1978 in control groups. Six reviews scored at low risk of bias and three at high risk. Meta-analysis demonstrated that IPLA reduced the mean pain score (0-10 scale) by 0.95 point (95% confidence interval: 0.73-1.17). Excluding laparoscopic cholecystectomy, the effect size increased to 1.52 (95% confidence interval: 1.15-1.88). Heterogeneity was high overall at I2 = 91.7% but on excluding laparoscopic cholecystectomy trials reduced to I2 = 31.3%. CONCLUSIONS: IPLA could be considered a viable option for early postoperative analgesia in certain laparoscopic operations. Further research on the effect of IPLA on procedures other than laparoscopic cholecystectomy would help clarify its place in a postoperative analgesia protocol.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Dolor Postoperatorio/tratamiento farmacológico , Anestésicos Locales/uso terapéutico , Humanos , Infusiones Parenterales , Inyecciones Intraperitoneales , Modelos Estadísticos , Literatura de Revisión como Asunto , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of this study was to investigate the efficacy of intraperitoneal local anesthetic (IPLA) on pain after acute laparoscopic appendectomy in children. SUMMARY OF BACKGROUND: IPLA reduces pain in adult elective surgery. It has not been well studied in acute peritoneal inflammatory conditions. We hypothesized that IPLA would improve recovery in pediatric acute laparoscopic appendectomy. METHODS: This randomized controlled trial in acute laparoscopic appendectomy recruited children aged 8 to 14 years to receive 20âmL 0.25% or 0.125% bupivacaine (according to weight) atomized onto the peritoneum of the right iliac fossa and pelvis, or 20âmL 0.9% NaCl control. Unrestricted computer-generated randomization was implemented by surgical nurses. Participants, caregivers, and outcome assessors were blinded. The primary outcome was pain score. Analysis was by a linear mixed-effects model. RESULTS: Of 184 randomized participants (92 to each group), the final analysis included 88 IPLA and 87 control participants. There was no statistically significant difference in overall pain scores (effect estimate 0.004, standard error 0.028, 95% confidence interval -0.052, 0.061), and no difference in right iliac fossa or suprapubic site-specific pain scores, opioid use, recovery parameters, or complications. No child experienced a complication related to the intervention. CONCLUSION: IPLA imparted no clinical benefit to children undergoing acute laparoscopic appendectomy and cannot be recommended in this setting.
Asunto(s)
Anestesia Local , Anestésicos Locales/administración & dosificación , Apendicectomía/efectos adversos , Bupivacaína/administración & dosificación , Laparoscopía/efectos adversos , Dolor Postoperatorio/prevención & control , Enfermedad Aguda , Adolescente , Apendicitis/cirugía , Niño , Método Doble Ciego , Femenino , Humanos , Masculino , Dolor Postoperatorio/etiología , Estudios ProspectivosRESUMEN
Introduction Systematic reviews report intraperitoneal local anesthetic (IPLA) effective in adults but until now no review has addressed IPLA in children. The objective of this review was to answer the question, does IPLA compared with control reduce pain after pediatric abdominal surgery. Materials and Methods Data sources: MEDLINE, EMBASE, Cochrane databases, trials registries, ProQuest, Web of Science, Google Scholar, and Open Gray. STUDY SELECTION: Independent duplicate searching for randomized controlled trials of IPLA versus no IPLA/placebo in children ≤ 18 years of age, reporting pain, or opioid use outcomes. DATA EXTRACTION: Independent duplicate data extraction and quality assessment using standardized fields. Results The selection process uncovered three eligible published trials and one unpublished study, all in laparoscopy surgery. Qualitative synthesis suggested that IPLA may reduce pain scores, opioid use, time to first opioid, and the need for rescue analgesia, with no effect on hospital stay. Risk of bias was significant. Conclusions IPLA appears promising in pediatric surgery. The high absorptive capacity of the peritoneum and high peritoneal surface area to volume ratio in children presents a dose limitation. In comparison to adult surgery, IPLA has been understudied in pediatric surgery.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Dimensión del Dolor/clasificación , Dolor Postoperatorio/tratamiento farmacológico , Abdomen/cirugía , Adolescente , Adulto , Analgésicos Opioides/administración & dosificación , Niño , Preescolar , Humanos , Inyecciones Intraperitoneales/métodos , Laparoscopía , Dolor Postoperatorio/prevención & control , Peritoneo/cirugía , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term 'appendicitis' and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention.