Assessment of wound infiltration with bupivacaine in women undergoing day-case gynecological laparoscopy

Background and Objectives: The effectiveness of local anesthetic wound infi ltration for treatment of postoperative pain appears to be variable and par tly dependent on the surgical procedure. Although evidence was lacking, it was common practice at our institution to infiltrate the trocar wound of pa tients undergoing day-case laparoscopic procedures with long acting local a nesthetic agents. The aim of this study was to investigate the analgesic ef ficacy, and the influence of the timing, of local anesthetic infiltration i nto surgical wounds for day-case diagnostic gynecological laparoscopy. Methods: A double-blind, randomized trial was conducted on 100 women having general anesthesia for day-case gynecological laparoscopy. Ninety-two pati ents who had been randomized to 1 of 4 groups for trocar wound infiltration with 30 mL of 0.25% bupivacaine or saline either before or after surgery c ompleted the study. Incisional pain, pain on pressing the umbilicus, severi ty of nausea, and patient satisfaction with anesthetic technique were all a ssessed postoperatively until discharge and on the following day through a telephone interview. A P value of <.05 was considered significant. Results: There was no difference between groups in the mean pain scores or analgesic requirements for incisional pain, pain on pressing firmly on the umbilicus, or for patient satisfaction. There was a trend for those patient s who had received bupivacaine to use less postoperative morphine (P = .079 ). Conclusions: Wound infiltration with local anaesthetic did not significantl y reduce pain or opioid require ment after gynecological laparoscopy.