Effects of intraperitoneal lidocaine combined with intravenous or intraperitoneal tenoxicam on pain relief and bowel recovery after laparoscopic cholecystectomy

Background: Previous work has demonstrated that intraperitoneal (i.p.) lido caine may provide analgesia after laparoscopic cholecystectomy. The aim of this prospective, randomized, double-blind study was to compare pain relief , recovery variables, and side effects after i.p. instillation of lidocaine plus tenoxicam given either i.v. or i.p. after laparoscopic cholecystectom y. Methods: Ninety patients were randomly allocated to one of three groups to receive either 200 mi normal saline i.p. and 2 mi of normal saline i.v. (sa line group), 200 mi lidocaine 0.1% i.p. and 2 mi tenoxicam 20 mg i.v. (teno xicam i.v. group), or 200 mi lidocaine 0.1% with 20 mg tenoxicam i.p. and 2 mi of normal saline i.v. (tenoxicam i.p. group). The i.p. instillation was made under the right diaphragm and on the gall bladder bed. VAS pain score s at rest, on movement and during coughing, were measured 2, 4, 6, 12, and 24 h after operation. The time to first demand of analgesia, total analgesi c requirement, recovery variables, and side effects were investigated. Results: In the tenoxicam i.p. group, pain scores were significantly lower both at rest and on movement and analgesic consumption was reduced compared with the saline group (P<0.05). Zn the tenoxicam i.v. group, pain scores a t rest were significantly lower compared with the saline group. Although re covery of bowel function was significantly faster in the tenoxicam i.p. gro up (P<0.05), there were no differences in any other recovery characteristic s or incidence of nausea between the groups. Conclusion: Combination of intraperitoneal lidocaine and tenoxicam provided better analgesia on movement, and faster return of bowel function compared with i.p. lidocaine and i.v. tenoxicam during the 24 h period after surger y.