Analgesia posoperatoria en la videolaparascopía de urgencia mediante irrigación de bupivacaína intraperitoneal / Posoperative analgesia in emergency videolaparoscopy through intraperitoneal bupivacaine irrigation

Introducción: La videolaparascopía es un procedimiento frecuente en los servicios de urgencias de cirugía general. El dolor agudo después de estas intervenciones es de naturaleza compleja y requiere un tratamiento analgésico efectivo. Objetivo: Determinar la utilidad del empleo de bupivacaína intraperitoneal en el alivio del dolor posoperatorio en la videolaparascopía de urgencia. Métodos: Se realizó un estudio longitudinal prospectivo y analítico en 80 pacientes mayores de 18 años, anunciados para videolaparoscopía bajo anestesia general orotraqueal en el servicio de urgencias del HMC: Dr. Luis Díaz Soto, desde septiembre de 2016 hasta septiembre de 2018. Los pacientes fueron divididos aleatoriamente en dos grupos de 40 cada uno. Al grupo 1 se aplicó lidocaína transdérmica preincisional en las incisiones de piel y, al término de la cirugía, se irrigaron ambos hemidiafragmas con bupivacaína al 0,25 por ciento. Al grupo 2 se le administró dosis preincisional de analgésicos endovenosos solamente. Resultados: Predominó significativamente el sexo femenino sin diferencia entre grupos. La analgesia posoperatoria fue mejor en el grupo 1 estadísticamente significativa a las 4, 8 y 12 horas. Los requerimientos de analgesia de rescate fueron menores en el grupo 1 (p=0,0024). No se reportaron efectos adversos. Conclusiones: La administración de lidocaína transdérmica preincisional y la instilación de bupivacaína intraperitoneal al final de la videolaparoscopía de urgencia, reduce significativamente el dolor en las primeras horas de posoperatorio. Su aplicación es sencilla, fácil y segura sin evidencias de efectos adversos(AU)

Introduction: Videolaparoscopy is a frequent general surgery procedure in emergency services. Acute pain after these interventions is complex in nature and requires effective analgesic treatment. Objective: To determine the usefulness of intraperitoneal bupivacaine in the relief of postoperative pain in emergency videolaparoscopy. Methods: A prospective, analytical and longitudinal study was carried out in eighty patients older than eighteen years old, announced for videolaparoscopy under orotracheal general anesthesia in the emergency department of Hospital Militar Central Dr. Luis Díaz Soto, from September 2016 to September 2018. The patients were randomly divided into two groups of forty individuals each. Group 1 was applied pre-incisional transdermal lidocaine on skin incisions and, at the end of surgery, both hemidiaphragms were irrigated with bupivacaine 0.25 percent. Group 2 received pre-incisional doses of intravenous analgesics only. Results: The female sex predominated significantly, without difference between the two groups. Postoperative analgesia was better in group 1, insofar it was statistically significant at four, eight and twelve hours. Rescue analgesia requirements were lower in group 1 (p=0.0024). No adverse effects were reported. Conclusions: The administration of pre-incisional transdermal lidocaine and the instillation of intraperitoneal bupivacaine at the end of emergency videolaparoscopy significantly reduces pain during the first hours after surgery. Its application is simple, easy and safe, without evidence of adverse effects(AU)

Effect of Adding Hydrocortisone to Intraperitoneal Bupivacaine in Laparoscopic Bariatric Surgery.

BACKGROUND: Bariatric surgery is the effective management of obesity; however, postoperative pain is associated with a great morbidity. The management of pain is important for the enhancement of patient recovery. Local anesthetics can be injected during laparoscopic surgery into the peritoneum throughout the ports produced either before the beginning of laparoscopy or before the closure of the wound to reduce postoperative pain. Our aim is to evaluate if there is an additive analgesic effect by the administration of intraperitoneal hydrocortisone with streamed intraperitoneal bupivacaine as a method of postoperative pain relief in laparoscopic bariatric surgeries. PATIENTS AND METHODS: One hundred patients listed for laparoscopic bariatric surgery were the subject of this study. Patients were randomly allocated into two groups: Group I received 100 mg of 0.5% isobaric bupivacaine plus 20 mL normal saline intraperitoneally and Group II received intraperitoneal 100 mg of 0.5% isobaric bupivacaine + 100 mg hydrocortisone + 20 mL of saline at the end of the laparoscopic procedure. The primary outcome was the Visual Analog Scale (VAS) score for pain. The secondary outcomes were the time of first analgesic request, total opioid requirement, heart rate, and mean blood pressure. RESULTS: VAS showed a significant decrease at 4, 6, and 12 h postoperative in Group II compared to Group I. There was a marked decrease in total meperidine requirement with prolonged time of the first analgesic request in Group II compared to Group I. CONCLUSION: Intraperitoneal hydrocortisone with bupivacaine had improved postoperative pain relief with a decrease in analgesic requirement.

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial.

OBJECTIVE: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy. METHODS: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively. RESULTS: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions. CONCLUSION: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441.

Combination of a pulmonary recruitment maneuver and intraperitoneal bupivacaine for the reduction of postoperative shoulder pain in gynecologic laparoscopy: a randomized, controlled trial

OBJECTIVE: To compare the efficacy of a pulmonary recruitment maneuver using lower airway pressure (30 cm H2O) and intraperitoneal bupivacaine, alone or in combination, for reducing shoulder pain after gynecologic laparoscopy.METHODS: A prospective controlled study was performed in a teaching hospital with patients who underwent elective gynecologic laparoscopic surgery. Two hundred eighty-seven patients were randomized into 1 of 4 groups: group A, placebo; group B, intraperitoneal instillation of bupivacaine; group C, CO2 removal by a pulmonary recruitment maneuver; group D, combination of intraperitoneal bupivacaine and pulmonary recruitment maneuver. The interventions were performed at the end of surgery. Shoulder pain was recorded on a visual analog scale (VAS) at 1, 6, 12, and 24 hours postoperatively.RESULTS: The overall incidence of shoulder pain was 49.8% and the incidence tended to gradually decrease from group A to group D (59.0% in group A, 54.8% in group B, 44.4% in group C, and 41.5% in group D; P=0.026). In addition, the VAS scores gradually decreased from group A to D, although a statistically significant difference was only found at 6 hours postoperatively (P=0.03). There were no complications related to the interventions.CONCLUSION: The combination of a pulmonary recruitment maneuver with intraperitoneal bupivacaine significantly reduced shoulder pain after gynecologic laparoscopy.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01039441

The Use of Intraperitoneal Bupivacaine in Laparoscopic Roux-en-Y Gastric Bypass: a Double-blind, Randomized Controlled Trial.

BACKGROUND: Several studies have shown a reduction in postoperative pain and length of hospital stay when using intraperitoneal local anesthetics during laparoscopic surgery. In morbidly obese patients, respiratory depression due to opioid use is a serious side effect. Any different type of analgesia is therefore clinically relevant. OBJECTIVE: To assess the effect of intraperitoneal bupivacaine on postoperative pain after laparoscopic Roux-en-Y gastric bypass (LRYGB). METHODS: Between March and November 2017, 130 patients were included and randomly assigned to receive 20 ml or 0 ml of 2.5% bupivacaine hydrochloride sprayed onto the diaphragm. Pain scores for abdominal and shoulder pain were conducted using the visual analogue scale (VAS) for pain score at 0, 1, 6, and 24 h postoperatively. The length of hospital stay and use of analgesics was recorded in digital patient records. The primary outcome is the pain scores and the secondary outcomes are postoperative use of opioids or antiemetics and length of hospital stay. RESULTS: The study and control group contained respectively 66 and 61 patients. Patient characteristics were equal in both groups (p < 0.05), except for age. No significant reduction of postoperative pain or opioid use was seen with the use of intraperitoneal bupivacaine. There was also no significant reduction in the use of antiemetics and length of hospital stay. CONCLUSION: The use of intraperitoneal bupivacaine in LRYGB does not show a statistically significant reduction in postoperative pain or postoperative opioid use. Therefore, using intraperitoneal bupivacaine has no clinical relevance and should no longer be used in LRYGB.

Analgesic Effect of Intraperitoneal Bupivacaine Hydrochloride After Laparoscopic Sleeve Gastrectomy: a Randomized Clinical Trial.

BACKGROUND: The indications for sleeve gastrectomy as a primary procedure for the surgical treatment of morbid obesity have increased worldwide. Pain is the most common complaint for patients on the first day after laparoscopic sleeve gastrectomy. There are various methods for decreasing pain after laparoscopic sleeve gastrectomy such as the use of intraperitoneal bupivacaine hydrochloride. This clinical trial was an attempt to discover the effects of intraperitoneal bupivacaine hydrochloride on alleviating postoperative pain after laparoscopic sleeve gastrectomy. METHODS: In general, 120 patients meeting the inclusion criteria were enrolled. Patients were randomly allocated into two interventions and control groups using a balanced block randomization technique. One group received intraperitoneal bupivacaine hydrochloride (30 cm3), and the other group served as the control one and did not receive bupivacaine hydrochloride. Diclofenac suppository and paracetamol injection were administered to both groups for postoperative pain management. RESULTS: The mean subjective postoperative pain score was significantly decreased in patients who received intraperitoneal bupivacaine hydrochloride within the first 24 h after the surgery; thus, the instillation of bupivacaine hydrochloride was beneficial in managing postoperative pain. CONCLUSIONS: The intraoperative peritoneal irrigation of bupivacaine hydrochloride (30 cm3, 0.25%) in sleeve gastrectomy patients was safe and effective in reducing postoperative pain, nausea, and vomiting (IRCT2016120329181N4).

Efficacy and safety of intraperitoneal dexmedetomidine with bupivacaine in laparoscopic colorectal cancer surgery, a randomized trial.

OBJECTIVE: Our objective is to investigate the efficacy and safety of intraperitoneal dexmedetomidine (Dex) combined with bupivacaine in patients undergoing laparoscopic colorectal cancer surgery. DESIGN: Randomized double-blind study. SETTING: Academic medical center. PATIENTS AND METHODS: Forty-five patients scheduled for laparoscopic colorectal cancer surgery were randomly assigned for intraperitoneal administration of 50 mL saline (control group; GI, n = 15), 50 mL bupivacaine 0.25% (125 mg; GII, n = 15), or 50 mL bupivacaine 0.25% (125 mg) +1 µg/kg Dex (GIII, n = 15). Patients were assessed during the first 24 hours postoperatively for hemodynamics, visual analogue scale (VAS), time to first request of analgesia, total analgesic consumption, shoulder pain, and side effects. RESULTS: A significant reduction was observed in VAS in GIII at base line, 2, 4, and 24 hours postoperatively in comparison to GI and GII (P < 0.05). The time to first analgesic requirement was significantly prolonged in GIII (P < 0.05). The mean total consumption of rescue analgesia was significantly reduced in GIII. CONCLUSION: We conclude that intraperitoneal administration of Dex 1 µg/kg combined with bupivacaine improves the quality and the duration of postoperative analgesia and provides an analgesic sparing effect compared to bupivacaine alone without significant adverse effects in patients undergoing laparoscopic colorectal cancer surgery.