B. Scheinin et al., EFFECT OF INTRAPERITONEAL BUPIVACAINE ON PAIN AFTER LAPAROSCOPIC CHOLECYSTECTOMY, Acta anaesthesiologica Scandinavica, 39(2), 1995, pp. 195-198
The effect of intraperitoneal bupivacaine on postoperative pain was st
udied in 60 ASA 1-2 patients undergoing elective laparoscopic cholecys
tectomy. The patients were randomly selected (20 patients in each grou
p) to receive in double-blind fashion 100 ml of either plain 0.15% bup
ivacaine (150 mg . 100 ml(-1)) or the same solution with adrenaline (1
.5 mu g . ml(-1)), or the same volume of saline into the right subdiap
hragmatic space at the end of surgery. The patients Here kept in the T
rendelenburg's position for 20 min after the instillation. Venous bloo
d samples for the determination of bupivacaine plasma concentrations w
ere drawn up to 180 min. Plasma bupivacaine concentrations peaked at 3
0 min (highest individual value 2.6 mu g ml(-1)) after instillation. B
upivacaine concentrations were significantly lower in the bupivacaine-
adrenaline group. During the follow-up no difference between the group
s occurred as to the time to first demand of analgesia, severity of po
stoperative pain, amount of consumed analgesics during 7 days, and len
gth of hospitalization In all groups, 30-45% of the patients complaine
d of right shoulder pain. After the first 24 hours, pain at rest and d
uring moving was reported as mild and was managed with oral ketoprofen
. It is concluded that postsurgical intraperitoneal instillation of 15
0 mg bupivacaine in 100 mt of saline had no effect on pain after lapar
oscopic cholecystectomy.