Can intraperitoneal bupivacaine decreases pain in patients undergoing laparoscopic live donor nephrectomy? A randomized control trial.
Jairath A, Ganpule A, et al.World Journal of Urology 2017; 35(6): 985-989.
Aims
To evaluate the effect of intraperitoneal bupivacaine (BC) in alleviating postoperative pain in patients undergoing laparoscopic live donor nephrectomy.
Interventions
Participants were randomised to receive intraperitoneally either 20mL of 0.5 % BC (study group), versus 20mL of 0.9 % normal saline (control group).
Participants
100 patients scheduled for laparoscopic donor nephrectomy under a standardized general anesthesia technique.
Outcomes
Outcomes measured included postoperative pain scores at 0, 2, 4, 8, 16 and 24 h, time to first analgesia and cumulative 24-h analgesic consumption, heart rate, blood pressure, respiratory rate, blood oxygen saturation, temperature and the incidence of adverse effects.
Follow-up
24 hours
CET Conclusions
This study investigates the use of intraperitoneal bupivacaine at the end of a live donor nephrectomy to improve analgesia. Donors were randomised to instillation of either 20ml bupivacaine or 20mls normal saline to the renal bed/perisplenic area. Patients having bupivacaine instilled demonstrated lower early post-operative pain scores, and lower rescue analgesic use, than those receiving placebo. There are a few points to note. Firstly, no local anaesthetic was instilled around the wounds at the end of the procedure. This is common practice, and it is therefore unclear how intraperitoneal bupivacaine compares to local infiltration or whether it offers any additional benefit. Secondly, the clinical significance of the difference in pain scores observed is small. Previous studies have demonstrated that the minimum clinically significant difference on a 10-point VAS is 1.2, which was only achieved at 0h post-op in the present study. The accuracy of a VAS in a patient immediately after general anaesthesia is questionable at best. Further studies are needed to see if intraperitoneal bupivacaine adds any additional benefit over and above local wound infiltration.
Data analysis
Per protocol analysis
Trial registration
None