Author(s): Linnelle Stacy T. Lao, MD; Pierre Pepito R. Hao, MD and Maila Rose L. Torillo, MD, FPCS, FPSGS
The analgesic effect of intraperitoneal bupivacaine has been widely studied, but with controversial results.
To determine the efficacy of intraperitoneal bupivacaine on producing postoperative analgesia in patients who underwent laparoscopic cholecystectomy.
A systematic literature search on the use of intraperitoneal bupivacaine in reducing postoperative pain was done using Medline and Cochrane. The search yielded 6 randomized controlled trials, involving a total of 440 patients. Mean differences in visual analog pain score at 0, 2, 4, 6, 8, 12, and 24 hours post-surgery were pooled using random effects model.
Overall, there was a significant reduction of pain score in the bupivacaine group with VAS score of -0.55 cm (95% CI, -0.80 to -0.31). Subgroup analysis at 0, 2, 4, 6, 8, and 12 hours post-surgery showed statistically significant mean differences in the VAS score of -1.59 cm (95% CI, -2.31 to -0.86), -0.60 cm (95% CI, -1.02 to – 0.17), -0.80 cm (95% CI, -1.34 to -0.26), -0.85 cm (95% CI, -1.46 to -0.24), -0.64 cm (95% CI, -1.12 to -0.16), and -0.38 cm (95% CI, -0.68 to -0.08), respectively, in favor of the bupivacaine group. However, at 24 hours post-surgery, there was no statistically significant mean difference in the VAS score of -0.09 cm (95% CI, -0.49 to 0.31).
Intraperitoneal bupivacaine instillation among patients undergoing laparoscopic cholecystectomy is effective in providing postoperative analgesia specifically in the first 12 hours post-op.
Key words: intraperitoneal bupivacaine, bupivacaine, laparoscopic cholecystectomy, postoperative pain, pain