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Prophylacticip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery

L’injection intrapéritonéale préventive de bupivacaïne et/ou de morphine n’améliore pas l’analgésie postopératoire après une intervention gynécologique laparoscopique

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Abstract

Purpose

To determine the effectiveness ofip bupivacaine and/or morphine for postoperative analgesia after laparoscopic surgery. A controversy exists on the effectiveness and clinical value ofip injection of local anesthetics for postoperative analgesia. A possible peripheral analgesic effect of morphine afterip injection remains debated as well.

Methods

We conducted a randomized, double-blinded, study to compare the efficacy of prophylacticip administration of 0.9% saline (n = 16), 0.5% bupivacaine (100 mg,n = 15), morphine (3 mg,n = 16) and a mixture with 0.5% bupivacaine (100 mg) and morphine (3 mg,n = 18) to reduce both postoperative pain scores and analgesic requirements after gynecologic laparoscopic surgery. A multimodal analgesia regimen (acetaminophen, nonsteroidal antiinflammatory drugs and morphine) was used for postoperative analgesia.

Results

No difference was observed in postoperative pain scores (visual analogue scale at rest and on coughing), or analgesic requirements during the first 24 postoperative hours between the four groups. There was also no significant intergroup difference in sedation scores and incidence of nausea and vomiting.

Conclusion

When multimodal postoperative analgesia is used, prophylacticip administration of 100 mg bupivacaine and/or 3 mg morphine does not significantly improve postoperative analgesia in patients undergoing laparoscopic gynecologic surgery.

Résumé

Objectif

Déterminer l’efficacité de l’administration intrapéritonéale ip de bupivacaïne et/ou de morphine pour l’analgésie postopératoire en chirurgie laparoscopique. L’efficacité et la valeur clinique de l’injection ip d’anesthésiques locaux pour l’analgésie postopératoire, de même que l’effet analgésique périphérique possible de la morphine après l’injection ip, demeurent discutables.

Méthode

Létude, randomisée et à double insu, voulait comparer l’efficacité de l’administration ip prophylactique de solution saline à 0,9 %(n= 16), de 100 mg de bupivacaine à 0,5 % (n = 15), de 3 mg de morphine (n = 16) et d’un mélange de 100 mg de bupivacaine à 0,5 % et de 3 mg de morphine (n = 18) pour réduire la douleur postopératoire et les besoins analgésiques à la suite d’une intervention gynécologique laparoscopique. Une analgésie multimodale (acétaminophène, anti-inflammatoires non stéroïdiens et morphine) a été utilisée pour l’analgésie postopératoire.

Résultats

Aucune différence intergroupe n’a été observée quant aux scores de douleur postopératoire (échelle visuelle analogique au repos et pendant la toux) ou aux besoins analgésiques pendant les 24 premières heures postopératoires. Les scores de sédation et l’incidence de nausées et de vomissements n’ont pas présenté non plus de différence intergroupe.

Conclusion

Quand on utilise une analgésie postopératoire multimodale, l’administration prophylactique ip de 100 mg de bupivacaine et/ou de 3 mg de morphine n’améliore pas signifcativement l’analgésie postopératoire en chirurgie gynécologique laparoscopique.

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Correspondence to Hawa Keita.

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Keita, H., Benifla, J.L., Le Bouar, V. et al. Prophylacticip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery. Can J Anesth 50, 362–367 (2003). https://doi.org/10.1007/BF03021033

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Keywords

  • Morphine
  • Laparoscopic Cholecystectomy
  • Bupivacaine
  • Ropivacaine
  • Alfentanil