Intraperitoneal lidocaine for postoperative pain after laparoscopy

Background: A controversy exists over the effectiveness and clinical value of intraperitoneal local anaesthetics for treating pain after laparoscopic cholecystectomy. The use of intraperitoneal lidocaine was evaluated in this study. Methods: At the end of surgery, 200 mi saline containing 200 mg lidocaine, or the same volume of saline, were randomly splashed under the right diaphr agmatic surface in 50 patients in a double-blind manner. Postoperative shou lder and abdominal pain intensity were recorded on a numeric grading scale and a visual analogue scale, respectively. Analgesic consumption was also r ecorded. Respiratory function tests were compared before and after surgery. Side effects and recovery variables were assessed by the nurses at 2-h int ervals. Results: The incidence, severity and duration of shoulder pain were reduced from 40% of patients scoring 3.9+/-0.2 for duration of 17.9+/-0.2 h in the control group to 12% scoring 2.5+/-0.5 for duration of 1.6+/-0.01 h in the lidocaine group. Lidocaine treated patients had significantly less abdomin al postoperative pain immediately on return to the ward and during the firs t postoperative day (P<0.05). "No pain on deep inspiration" was reported by 72% of patients in the lidocaine group immediately on return to the ward c ompared to 8% of those in the control group. Analgesic consumption for 24 h after surgery was significantly less in the lidocaine group (P<0.05), Ther e were no significant differences in respiratory function tests, recovery v ariables or incidence of side effects between the two groups. Conclusion: Intraperitoneal lidocaine is simple to use and results in a lon g-lasting reduction of pain after a single administration.