A PROSPECTIVE RANDOMIZED TRIAL OF INTRAOPERATIVE BUPIVACAINE IRRIGATION FOR MANAGEMENT OF SHOULDER TIP PAIN FOLLOWING LAPAROSCOPY

BACKGROUND: Postoperative shoulder-tip pain (STP) frequently occurs fo llowing laparoscopic surgery, In an attempt to abrogate this complicat ion we prospectively evaluated the efficacy of intraoperative irrigati on of the diaphragm with bupivacaine, METHODS: One hundred and five co nsecutive patients undergoing laparoscopic surgery were prospectively randomized to treatment or control groups. Treatment group (B, n = 55) received irrigation with 10 mt 0.5% bupivacaine in 500 mt saline and control group (A, n = 50) received an equal Volume of normal saline. E ach dome of the diaphragm was irrigated with 250 mt of either solution at the end of surgery. Laparoscopic procedures performed included cho lecystectomy (n = 63), Nissen fundoplication (n = 21), appendicectomy (n = 7), hernia repair (n = 4), and diagnostic laparoscopy (n = 10). P atients' anesthesia and perioperative analgesia were standardized. STP was recorded on a visual analogue pain scale (VAPS) in the recovery r oom immediately following surgery and at 4, 10, and 24 hours thereafte r. RESULTS: The overall incidence of STP in patients undergoing laparo scopic procedures was approximately 24%. Twenty-one patients (42%) in the control group and 4 patients (7%) in the treatment group complaine d of shoulder pain during the recording period (P = 0.003), Mean STP s cores as recorded on VAPS were significantly lower in the bupivacaine group than in the control group from 4 to 24 hours after surgery (P <0 .01). Postoperative analgesia requirements were also significantly red uced in those patients receiving bupivacaine irrigation (P <0.04), CON CLUSION: Intraperitoneal irrigation with bupivacaine to both hemidiaph ragms at the end of surgery significantly reduces both frequency and i ntensity of STP following laparoscopic procedures thus reducing patien t morbidity. (C) 1998 by Excerpta Medica, Inc.