ABSORPTION OF BUPIVACAINE FROM THE PRE-PERITONEAL SPACE IN LAPAROSCOPIC HERNIA REPAIR

Local anaesthetic placed into the pre-peritoneal space during laparosc opic hernia repair may provide additional pain relief, reducing the re quirement for post-operative analgesia. The systemic absorption of suc h drugs from this space has not previously been determined. Twenty pat ients undergoing laparoscopic transperitoneal hernia repair were rando mly allocated to receive bupivacaine 1.5 mg/kg or bupivacaine 1.5 mg/k g with 1.200 000 adrenaline. Venous blood samples were obtained at 10, 15, 30, 60 and 90 min following instillation of bupivacaine. Plasma l evels of bupivacaine at these times were determined using high pressur e gas liquid chromatography. No patient experienced signs or symptoms of bupivacaine toxicity. Mean plasma concentrations of bupivacaine pea ked at 30 min and did not reach toxic levels. The addition of adrenali ne did not significantly alter the systemic absorption of bupivacaine. Instilling bupivacaine 1.5 mg/kg into the pre-peritoneal space is ass ociated with a low risk of toxicity. The addition of adrenaline is unn ecessary and can be omitted from further trials. This information shou ld facilitate the study of post-operative analgesia requirements follo wing laparoscopic hernia repair.