Hostname: page-component-77c89778f8-vpsfw Total loading time: 0 Render date: 2024-07-22T04:26:13.987Z Has data issue: false hasContentIssue false
  • English
  • Français

Is intraperitoneal levobupivacaine with epinephrine useful for analgesia following laparoscopic cholecystectomy? A randomized controlled trial

Published online by Cambridge University Press:  23 December 2004

A. Ng ,
A. Swami ,
G. Smith ,
G. Robertson  and
D. M. Lloyd
A. Ng
Affiliation:
Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care and Pain Management, Leicester, UK
A. Swami
Affiliation:
Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care and Pain Management, Leicester, UK
G. Smith
Affiliation:
Leicester Royal Infirmary, University Department of Anaesthesia, Critical Care and Pain Management, Leicester, UK
G. Robertson
Affiliation:
Leicester Royal Infirmary, Department of Surgery, Leicester, UK
D. M. Lloyd
Affiliation:
Leicester Royal Infirmary, Department of Surgery, Leicester, UK
Get access

Abstract

Summary

Background and objective: A randomized controlled trial of patients undergoing laparoscopic cholecystectomy. To evaluate whether the instillation of levobupivacaine, with epinephrine, intraperitoneally, reduces morphine consumption; further, to consider the degree of abdominal and shoulder pain in the presence of local anaesthetic at the site of surgical incision.

Methods: Patients received a standardized procedure and were allocated randomly to receive either (a) 2.5 mg mL−1 levobupivacaine 30 mL, with epinephrine 5 μg mL−1, or (b) normal saline 30 mL, with epinephrine 5 μg mL−1, to the bed of the gall bladder and above the liver, immediately before wound closure.

Results: Median (interquartile range) total abdominal pain during inspiration in the levobupivacaine group was significantly (P = 0.041) lower (71 (21–129) mm) than that in the placebo group (123 (71–179) mm). However, there was no significant difference between the two groups with respect to total abdominal pain at rest, right shoulder pain or the consumption of rescue morphine and rescue dihydrocodeine. There were no differences between the two groups with respect to the administration of cyclizine, total nausea and total sedation scores. In addition, the number of episodes of vomiting was not significantly different.

Conclusions: Intraperitoneal administration of levobupivacaine with epinephrine is associated with modest analgesia following laparoscopic cholecystectomy.

Keywords

PAIN, postoperativeANAESTHETICS, LOCAL, levobupivacaineSURGERY, laparoscopic cholecystectomyRANDOMIZED CONTROLLED TRIALS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 653 - 657
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ng A, Parker J, Toogood L, Cotton BR, Smith G. Does the opioid-sparing effect of rectal diclofenac following total abdominal hysterectomy benefit the patient? Br J Anaesth 2002; 88: 714–716.Google Scholar
Ng A, Smith G, Davidson AC. Analgesic effects of parecoxib following total abdominal hysterectomy. Br J Anaesth 2003; 90: 746–749.Google Scholar
Ng A, Swami A, Smith G, Davidson AC, Emembolu J. The analgesic effects of intraperitoneal and incisional bupivacaine with epinephrine after total abdominal hysterectomy. Anesth Analg 2002; 95: 158–162.Google Scholar
Pasqualucci A, de Angelis V, Contardo R, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology 1996; 85: 11–20.Google Scholar
Elhakim M, Elkott M, Ali NM, Tahoun HM. Intraperitoneal lidocaine for postoperative pain after laparoscopy. Acta Anaesthesiol Scand 2000; 44: 280–284.Google Scholar
Gharaibeh KI, Al-Jaberi TM. Bupivacaine instillation into gallbladder bed after laparoscopic cholecystectomy: does it decrease shoulder pain? J Laparo Endosc Adv Surg Tech A 2000; 10: 137–141.Google Scholar
Ng A, Smith G. Intraperitoneal analgesia. Is it of any utility? Br J Anaesth 2002; 89: 535–537.Google Scholar
Raetzell M, Maier C, Schroder D, Wulf H. Intraperitoneal application of bupivacaine during laparoscopic cholecystectomy – risk or benefit? Anesth Analg 1995; 81: 967–972.Google Scholar
Scheinin B, Kellokumpu I, Lindgren L, Haglund C, Rosenberg PH. Effect of intraperitoneal bupivacaine on pain after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1995; 39: 195–198.Google Scholar
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesth Analg 1995; 81: 379–384.Google Scholar
Elfberg BA, Sjovall-Mjoberg S. Intraperitoneal bupivacaine does not effectively reduce pain after laparoscopic cholecystectomy: a randomized, placebo-controlled and double-blind study. Surg Laparosc Endosc Percutan Tech 2000; 10: 357–359.Google Scholar
Zmora O, Stolik-Dollberg O, Bar-Zakai B, et al. Intraperitoneal bupivacaine does not attenuate pain following laparoscopic cholecystectomy. J Soc Laparoendoscopic Surg 2000; 4: 301–304.Google Scholar
Moiniche S, Jorgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90: 899–912.Google Scholar
Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285–287.Google Scholar
Tucker GT. Chiral switches. Lancet 2000; 355: 1085–1087.Google Scholar
Chang DH, Ladd LA, Wilson KA, Gelgor L, Mather LE. Tolerability of large-dose intravenous levobupivacaine in sheep. Anesth Analg 2000; 91: 671–679.Google Scholar
Nancarrow C, Rutten AJ, Runciman WB, et al. Myocardial and cerebral drug concentrations and the mechanisms of death after intravenous doses of lidocaine, bupivacaine, and ropivacaine in the sheep. Anesth Analg 1989; 69: 276–283.Google Scholar
Huang YF, Pryor ME, Mather LE, Veering BT. Cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797–804.Google Scholar
Bardsley H, Gristwood R, Baker H, Watson N, Nimmo W. A comparison of the cardiovascular effects of levobupivacaine and rac-bupivacaine following intravenous administration to healthy volunteers. Br J Clin Pharmacol 1998; 46: 245–249.Google Scholar
Kopacz DJ, Allen HW. Accidental intravenous levobupivacaine. Anesth Analg 1999; 89: 1027–1029.Google Scholar
Crews JC, Rothman TE. Seizure after levobupivacaine for interscalene brachial plexus block. Anesth Analg 2003; 96: 1188–1190.Google Scholar
Pirotta D, Sprigge J. Convulsions following axillary brachial plexus blockade with levobupivacaine. Anaesthesia 2002; 57: 1187–1189.Google Scholar
Breslin DS, Martin G, Macleod DB, D’ercole F, Grant SA. Central nervous system toxicity following the administration of levobupivacaine for lumbar plexus block: a report of two cases. Reg Anesth Pain Med 2003; 28: 144–147.Google Scholar
Department of Health. In: Day Surgery: Operational Guide.London, UK: Department of Health Publications, 2002: 23.
Fujii Y, Toyooka H, Tanaka H. Efficacy of thoracic epidural analgesia following laparoscopic cholecystectomy. Eur J Anaesthesiol 1998; 15: 342–344.Google Scholar
Jorgensen JO, Gillies RB, Hunt DR, Caplehorn JR, Lumley T. A simple and effective way to reduce postoperative pain after laparoscopic cholecystectomy. Aust NZ J Surg 1995; 65: 466–469.Google Scholar