Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes a...

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Veröffentlicht in:Surgery 2009-09, Vol.146 (3), p.475-482
Hauptverfasser: Papadima, Artemisia, MD, Lagoudianakis, Emmanuel E., MD, Antonakis, Pantelis, MD, Filis, Konstantinos, PhD, Makri, Ira, MD, Markogiannakis, Haridimos, MD, Katergiannakis, Vaggelogiannis, PhD, Manouras, Andreas, PhD
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container_end_page 482
container_issue 3
container_start_page 475
container_title Surgery
container_volume 146
creator Papadima, Artemisia, MD
Lagoudianakis, Emmanuel E., MD
Antonakis, Pantelis, MD
Filis, Konstantinos, PhD
Makri, Ira, MD
Markogiannakis, Haridimos, MD
Katergiannakis, Vaggelogiannis, PhD
Manouras, Andreas, PhD
description Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. Methods A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. Results The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. Conclusion Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.
doi_str_mv 10.1016/j.surg.2009.04.010
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Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. Methods A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. Results The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. Conclusion Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. 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Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the digestive system]]></subject><ispartof>Surgery, 2009-09, Vol.146 (3), p.475-482</ispartof><rights>Mosby, Inc.</rights><rights>2009 Mosby, Inc.</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-d5cfb9bcaec1a3f37b949ba3632d6acec0bee4bc4d888ca6da5a26d007c435f53</citedby><cites>FETCH-LOGICAL-c439t-d5cfb9bcaec1a3f37b949ba3632d6acec0bee4bc4d888ca6da5a26d007c435f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.surg.2009.04.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=21933968$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19715804$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Papadima, Artemisia, MD</creatorcontrib><creatorcontrib>Lagoudianakis, Emmanuel E., MD</creatorcontrib><creatorcontrib>Antonakis, Pantelis, MD</creatorcontrib><creatorcontrib>Filis, Konstantinos, PhD</creatorcontrib><creatorcontrib>Makri, Ira, MD</creatorcontrib><creatorcontrib>Markogiannakis, Haridimos, MD</creatorcontrib><creatorcontrib>Katergiannakis, Vaggelogiannis, PhD</creatorcontrib><creatorcontrib>Manouras, Andreas, PhD</creatorcontrib><title>Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy</title><title>Surgery</title><addtitle>Surgery</addtitle><description>Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. Methods A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. Results The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. Conclusion Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.</description><subject>Analgesics, Opioid - administration &amp; dosage</subject><subject>Anesthetics, Local - administration &amp; dosage</subject><subject>Biological and medical sciences</subject><subject>Bupivacaine - administration &amp; dosage</subject><subject>Bupivacaine - analogs &amp; derivatives</subject><subject>Cholecystectomy, Laparoscopic - adverse effects</subject><subject>Cholelithiasis - surgery</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Fentanyl - administration &amp; dosage</subject><subject>General aspects</subject><subject>Humans</subject><subject>Infusions, Parenteral</subject><subject>Liver, biliary tract, pancreas, portal circulation, spleen</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Meperidine - administration &amp; dosage</subject><subject>Middle Aged</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - etiology</subject><subject>Pain, Postoperative - physiopathology</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the digestive system</subject><issn>0039-6060</issn><issn>1532-7361</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt-L1DAQx4so3nr6D_ggfdG3rpOmzbYgwnHoKRwI_ngO0-n0Lmub1CRd2P_e1F1O8MGnEPL5TmY-TJa9FLAVINTb_TYs_m5bArRbqLYg4FG2EbUsi51U4nG2AZBtoUDBRfYshD0ksBLN0-xCtDtRN1BtssNXnhkj97mx0ePM3kRnGcd0D9GMI0bjbO6GfOSD65bZHJDQWM4H5_N4z_mEFu94YhtXak5vOQ6RfT7ijN4FcrOhnO7dyHQMkSm66fg8ezLgGPjF-bzMfnz88P36U3H75ebz9dVtQZVsY9HXNHRtR8gkUA5y17VV26FUsuwVEhN0zFVHVd80DaHqscZS9QC7lK-HWl5mb051Z-9-LRyinkwgTmNZdkvQaqdKoQQksDyBlFoOngc9ezOhP2oBerWt93q1rVfbGioNf0KvztWXbuL-b-SsNwGvzwAGwnHwaMmEB64UrZStahL37sRxcnEw7HUgw5a4Nz4J070z_-_j_T9xGo016ceffOSwd4u3ybIWOpQa9Ld1L9a1gBagrOtK_gY0eLdi</recordid><startdate>20090901</startdate><enddate>20090901</enddate><creator>Papadima, Artemisia, MD</creator><creator>Lagoudianakis, Emmanuel E., MD</creator><creator>Antonakis, Pantelis, MD</creator><creator>Filis, Konstantinos, PhD</creator><creator>Makri, Ira, MD</creator><creator>Markogiannakis, Haridimos, MD</creator><creator>Katergiannakis, Vaggelogiannis, PhD</creator><creator>Manouras, Andreas, PhD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20090901</creationdate><title>Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy</title><author>Papadima, Artemisia, MD ; Lagoudianakis, Emmanuel E., MD ; Antonakis, Pantelis, MD ; Filis, Konstantinos, PhD ; Makri, Ira, MD ; Markogiannakis, Haridimos, MD ; Katergiannakis, Vaggelogiannis, PhD ; Manouras, Andreas, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-d5cfb9bcaec1a3f37b949ba3632d6acec0bee4bc4d888ca6da5a26d007c435f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Analgesics, Opioid - administration &amp; dosage</topic><topic>Anesthetics, Local - administration &amp; dosage</topic><topic>Biological and medical sciences</topic><topic>Bupivacaine - administration &amp; dosage</topic><topic>Bupivacaine - analogs &amp; derivatives</topic><topic>Cholecystectomy, Laparoscopic - adverse effects</topic><topic>Cholelithiasis - surgery</topic><topic>Double-Blind Method</topic><topic>Female</topic><topic>Fentanyl - administration &amp; dosage</topic><topic>General aspects</topic><topic>Humans</topic><topic>Infusions, Parenteral</topic><topic>Liver, biliary tract, pancreas, portal circulation, spleen</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Meperidine - administration &amp; dosage</topic><topic>Middle Aged</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - etiology</topic><topic>Pain, Postoperative - physiopathology</topic><topic>Prospective Studies</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the digestive system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Papadima, Artemisia, MD</creatorcontrib><creatorcontrib>Lagoudianakis, Emmanuel E., MD</creatorcontrib><creatorcontrib>Antonakis, Pantelis, MD</creatorcontrib><creatorcontrib>Filis, Konstantinos, PhD</creatorcontrib><creatorcontrib>Makri, Ira, MD</creatorcontrib><creatorcontrib>Markogiannakis, Haridimos, MD</creatorcontrib><creatorcontrib>Katergiannakis, Vaggelogiannis, PhD</creatorcontrib><creatorcontrib>Manouras, Andreas, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Papadima, Artemisia, MD</au><au>Lagoudianakis, Emmanuel E., MD</au><au>Antonakis, Pantelis, MD</au><au>Filis, Konstantinos, PhD</au><au>Makri, Ira, MD</au><au>Markogiannakis, Haridimos, MD</au><au>Katergiannakis, Vaggelogiannis, PhD</au><au>Manouras, Andreas, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy</atitle><jtitle>Surgery</jtitle><addtitle>Surgery</addtitle><date>2009-09-01</date><risdate>2009</risdate><volume>146</volume><issue>3</issue><spage>475</spage><epage>482</epage><pages>475-482</pages><issn>0039-6060</issn><eissn>1532-7361</eissn><coden>SURGAZ</coden><abstract>Background Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. Postoperative pain, however, can prolong hospital stay and lead to increased morbidity. In the context of a multimodal approach to analgesia, intraperitoneal local anesthetic administration optimizes analgesia and facilitates early postoperative recovery, and it may be associated with a decreased risk of side effects. Methods A total of 71 patients was randomized to receive either intraperitoneal analgesic (IPA group) or not (controls). At the completion of cholecystectomy, 10 mL of levobupivacaine 0.5% were infused intraperitoneally in the IPA group and 8 h postoperatively, whereas in the controls, 10 mL of 0.9% NaCl were administered in the corresponding points of time. Differences in pain scores between groups were the primary endpoints. Opioid consumption and adverse effects were the secondary endpoints. Results The 2 groups were homogenous in respect to age, sex, body mass index (BMI), and duration of operation. No conversion, complication, or mortality was recorded. The IPA group had a lesser visual analog scale score at rest and at movement compared with controls at all points of time measured. Moreover, fentanyl consumption in the recovery room was significantly greater in the control group, and the consumption of meperidine and the percentage of the patients that requested rescue analgesia in the ward was significantly greater in the control group. Local analgesic intraperitoneal injection as well as parecoxib for postoperative analgesia had no significant adverse effects. Conclusion Our study showed that 2 separate doses of intraperitoneally administered levobupivacaine significantly decreased postoperative pain and the need for opioids compared with placebo. This technique is simple, safe, and without adverse effects.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>19715804</pmid><doi>10.1016/j.surg.2009.04.010</doi><tpages>8</tpages></addata></record>
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subjects Analgesics, Opioid - administration & dosage
Anesthetics, Local - administration & dosage
Biological and medical sciences
Bupivacaine - administration & dosage
Bupivacaine - analogs & derivatives
Cholecystectomy, Laparoscopic - adverse effects
Cholelithiasis - surgery
Double-Blind Method
Female
Fentanyl - administration & dosage
General aspects
Humans
Infusions, Parenteral
Liver, biliary tract, pancreas, portal circulation, spleen
Male
Medical sciences
Meperidine - administration & dosage
Middle Aged
Pain Measurement
Pain, Postoperative - drug therapy
Pain, Postoperative - etiology
Pain, Postoperative - physiopathology
Prospective Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
title Repeated intraperitoneal instillation of levobupivacaine for the management of pain after laparoscopic cholecystectomy
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