Day-case laparoscopy: a comparison of prophylactic opioid, NSAID or local anesthesia for postoperative analgesia

Background: The study was aimed to evaluate the analgesic efficacy, postope rative comfort, recovery characteristics and side effects of three differen t analgesic agents administered prophylactically. Methods: Eighty patients undergoing day-case minor operative laparoscopy we re randomly allocated into four groups to receive tenoxicam 20 mg i.v. (Gro up T), fentanyl 100 mu g i.v. (Group F), 5 mi of bupivacaine 2.5 mg/ml for infiltration of trocar sites (Group B), 30, 10 and 5 min before incision re spectively. Bupivacaine, 35 mi, 2.5 mg/ml was also administered into the pe lvic cavity in Group B. Group P received only placebo. Postoperative pain, analgesic requirements, first response to verbal stimulus, first analgesic requirement, ability to walk without help, to drink and to void, blood pres sures, SpO(2) and respiration rates were recorded in the PACU. Postoperativ e pain was evaluated by verbal rating scale. Pain scores, analgesic require ments and side effects were evaluated by telephone calls until the 48th pos toperative hour. Results: Postoperative pain scores were lower and time to requirement of re scue analgesics was longer in groups F and B compared to Group P. In the PA CU, analgesic requirements were lower in Group B, compared to Group P. Naus ea and vomiting were increased in Group F Conclusion: Tenoxicam 20 mg i.v, was found to be ineffective whereas bupiva caine was superior to other groups in reducing pain and analgesic requireme nts. Bupivacaine also increased time to first analgesics and obtained bette r recovery characteristics, underlining its value in prophylactic pain mana gement compared to the other two agents. (C) Acta Anaesthesiologica Scandin avica 44 (2000).