A RANDOMIZED, DOUBLE-BLINDED TRIAL OF PREEMPTIVE ANALGESIA IN LAPAROSCOPY

Objective: We tested the hypothesis that local anesthetic administered before skin incision, an example of preemptive analgesia, reduces pos toperative pain for women undergoing laparoscopy, as compared with pos tincisional local anesthetic or placebo. Methods: Patients undergoing diagnostic laparoscopy were randomized to one of three blinded treatme nt groups. Treatment group A patients received local infiltration of 0 .5% bupivacaine at the surgical site before incision and a saline plac ebo infiltration before incision closure. Treatment group B received t he saline placebo before skin incision and bupivacaine after laparosco py but before closure of the skin incisions. For treatment group C pat ients, saline was infiltrated as a placebo before and after laparoscop y. All patients underwent a standardized general anesthetic induction and maintenance. Postoperative pain was evaluated using the modified M cGill Present Pain Intensity scale. Pain and supplementary analgesic u se was compared among the three treatment groups. Results: A total of 57 patients completed the study for analysis. Age, weight, height, rac e, indication, and operating time did not vary significantly between t he three groups. By 24 hours after surgery, patients in treatment grou p A reported significantly lower pain scores (McGill Present Pain Inte nsity Scale: 0.5 +/- 0.9) than either treatment group B (1.6 +/- 1.3) or C (1.3 +/- 1.2). Group A patients also could tolerate a significant ly longer time delay to their first analgesic medication than patients who received postincisional bupivacaine or than control patients who received no bupivacaine. Conclusion: The preemptive administration of bupivacaine before laparoscopy results in decreased postoperative pain and should allow a more rapid return to normal activities. The popula r practice of infiltrating bupivacaine at time of incision closure doe s not offer any benefit in the control of pain after laparoscopy. (Obs tet Gynecol 1998;92: 972-5. (C) 1998 by The American College of Obstet ricians and Gynecologists.).