Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: A placebo-controlled comparison of bupivacaineand ropivacaine

We tested the hypothesis that local anesthetics instilled at the end of lap aroscopic gynecologic procedures are able to prevent postoperative pain at wake-up and during the first 24 h. A total of 180 patients were randomly as signed into three groups to receive an intraperitoneal instillation of 20 m L of either bupivacaine 0.5% (Group B), ropivacaine 0.75% (Group R) or sali ne (Group S) at the end of surgery. All patients received analgesia with ac etaminophen and ketoprofen IV infusions. Pain was assessed by using a 0-10 graded numerical scale (NS) every 5 min in the postanesthesia care unit and IV morphine was administered if NS was >4. Assessment of pain was continue d every 4 h on the ward, and subcutaneous morphine was injected if needed t o keep the NS score < 4. Postoperative nausea and vomiting (PONV) was rated on a 4-point scale. The morphine consumption at wake-up and over the first 24 h was significantly lower (P < 0.05) in Group B (mean, 0.92 mg at wake- up; 3.08 mg over 24 h) and in Group R (mean, 0.25 mg at wake-up; 0.69 mg ov er 24 h), than in Group S (mean, 4.18 mg at wake-up; 12.93 mg over 24 h). T he morphine-sparing effect of ropivacaine was significantly greater than th at of bupivacaine. Both local anesthetics were effective in the prevention of PONV. We concluded that local anesthetics should be instilled in all gyn ecologic patients at the end of all laparoscopic procedures.