Intraperitoneal bupivacaine is an effective postoperative analgesic following laparascopic cholecystectomy, according to results of a meta-analysis presented here at the 2017 Annual Meeting of the American College of Surgeons (ACS).
“Intraperitoneal bupivacaine instillation effectively reduces post-operative pain in patients who underwent laparoscopic cholecystectomy, specifically in the first 12 hours postoperatively,” stated lead author Linnelle Lao, MD, Chinese General Hospital and Medical Center, Manila, Philippines, speaking here on October 24.
Dr. Lao and colleagues performed a literature review of the MEDLINE and COCHRANE databases, selecting 6 randomised controlled trials (1,765 patients) in which intraperitoneal bupivacaine was compared only with placebo in elective laparoscopic cholecystemctomies.
The authors found that bupivacaine (n = 880) performed significantly better than placebo (n = 885) in reducing pain, with a decrease in visual analog scale (VAS)-assessed pain of -0.55 cm (95% confidence interval [CI]: -0.80 to -0.31; P = .00001).
The numbers of patients at various times following completion of surgery allowed for a statistical subgroup analysis. The number of patients treated with buvipacaine examined at 0, 2, 4, 6, 8, 12, and 24 hours post-operatively were 60, 63, 163, 86, 103, 186, and 219, respectively. The number of patients receiving placebo at the same respective times were 60, 62, 162, 89, 102, 189, and 221.
In the subgroup analysis, statistically significant mean differences in the VAS score favoured bupivacaine. The values at 0, 2, 4, 6, 8, and 12 hours post-operatively were -1.59 cm (95% CI: -2.31 to -0.86; P = .0001), -0.60 cm (95% CI: -1.02 to -0.17; P = .000), -0.80 cm (95% CI: -1.34 to -0.26; P = .000), -0.85 cm (95% CI: -1.46 to -0.24; P = .000), -0.64 cm (95% CI: -1.12 to -0.16; P = .000), and -0.38 cm (95% CI: -0.68 to -0.08; P = .01).
Dr. Lao and colleagues found no significant benefit of bupivacaine at 24 hours post-operatively (-0.09 cm, 95% CI: -0.49 to 0.31; P = .06).
The authors chose to exclude studies from this analysis that compared intraperiteoneal bupivacaine with other interventions, those in which it was used to treat pain from acute cholecystitis or gallstone pancreatitis, those in which laparoscopic cholecystectomy was converted to open surgery, and those evaluating the use of intraperiteoneal bupivacaine during common bile-duct exploration.
Pain following laparscopic cholecystectomy can result from the destruction of nerve endings, disruption of visceral nerve endings in the gallbladder bed, release of endogenous inflammatory cytokines, and irritation of the phrenic nerve.
[Presentation title: Efficacy of Intraperitoneal Bupivacaine on Postoperative Analgesia in Laparoscopic Cholecystectomy: A Meta-Analysis.]