Recent evidence [Surg Endosc (2007) 21: 602–606] demonstrates that intraperitoneal bupivacaine administered as an aerosol via a special catheter is safe and significantly decreases postoperative pain in laparoscopic surgery. We currently use the Insuflow® device (Lexion Medical) routinely to warm and humidify gas in laparoscopic surgery. The purpose of this study is to determine whether using bupivacaine instead of water in existing technology already in use (Insuflow) will result in decreased postoperative pain, without increasing operative time or cost.
Using a double-blind methodology, 50 patients undergoing elective outpatient laparoscopic cholecystectomy were randomized to a study drug: either 10 ml of 0.5% bupivacaine (50 mg) or 10 ml of sterile water. The study drug was injected into the Insuflow in the standard fashion and the operation commenced routinely. No perioperative nonsteroidal anti-inflammatory drugs were used. Using a standard 0–10 pain-scoring scale, patients were assessed by perioperative nurses at 1 and 2 h postoperatively. Pain was again assessed at 24 h by telephone interview, along with the number of narcotic oral analgesics used in the first 24 h.
Fifty patients were randomized, 25 in each group; the groups were comparable. All patients completed the study and 100% follow-up was obtained. All patients were discharged the same day and there were no significant complications in either group, and specifically no complications attributed to bupivacaine or use of the Insuflow device. There were no differences in pain at 1 and 2 h. There was less pain in the bupivacaine group at 24 h, but this was not statistically significant (P = 0.055).
Bupivacaine use in the Insuflow device is safe. No significant differences in postoperative pain were noted in this study compared to using water.
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Alkhamesi NA, Peck DH, Lomax D, Darzi AW (2007) Intraperitoneal aerosolization of bupivacaine reduces postoperative pain in laparoscopic surgery: a randomized prospective controlled double-blind clinical trial. Surg Endosc 21:602–606
Beste TM, Daucher JA, Holbert D (2006) Humidified compared with dry, heated carbon dioxide at laparoscopy to reduce pain. Obstet Gynecol 107(2 Pt 1):263–268
Farley D, Greenlee S, Larson D, Harrington J (2004) Double blind, prospective, randomized study of warmed, humidified CO2 insufflation versus standard CO2 for patients undergoing laparoscopic cholecystectomy. J Arch Surg 139:739–744
Hamza MA, Schneider BE, White PF, Recart A, Villegas L, Ogunnaike B, Provost D, Jones D (2005) Heated and humidified insufflation during laparoscopic gastric bypass surgery: effect on temperature, postoperative pain, and recovery outcomes. J Laparoendosc Adv Surg Tech A 15(1):6–12
Mouton WG, Bessell JR, Millard SH, Baxter PS, Maddern GJ (1999) A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery. Surg Endosc 13:106–108
Ott DE, Reich H, Love B, McCorvey R, Toledo A, Liu CY, Syed R, Kumar K (1998) Reduction of laparoscopic-induced hypothermia, postoperative pain and recovery room length of stay by pre-conditioning gas with the Insuflow® device: a prospective randomized controlled multi-center study. JSLS 2:321–329
Kalayci MU, Akin BV, Alis H, Kapan S, Turhan AN, Aygun E (2008) Short-term effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain. Surg Endosc 22:1317–1320
Sharon A, Hirsh I, Kaufman Y, Ostrovski L, Brandes-Klein O, Spiegel D, Shenderey A, Lissak A (2008) The effect of continuous intraabdominal nebulization of lidocaine during gynecological laparoscopic procedures—a pilot study. Gynecol Surg 5:221–225
Pappas-Gogos G, Tsimogiannis KE, Zikos N, Nikas K, Manataki A, Tsimoyiannis EC (2008) Preincisional and intraperitoneal ropivacaine plus normal saline infusion for postoperative pain relief after laparoscopic cholecystectomy: a randomized double-blind controlled trial. Surg Endosc 22:2036–2045
Appreciation is extended to the Penrose-St. Francis Health Foundation for their financial support of this study. Thanks are also given to St. Francis Medical Center pharmacy manager Calvin Eisenach, RPh, for his assistance.
Drs. Zimmer, McCann, and O’Brien have no conflicts of interest or financial ties to disclose.
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Zimmer, P.W., McCann, M.J. & O’Brien, M.M. Bupivacaine use in the Insuflow® device during laparoscopic cholecystectomy: results of a prospective randomized double-blind controlled trial. Surg Endosc 24, 1524–1527 (2010). https://doi.org/10.1007/s00464-009-0804-9
- Postoperative pain
- Randomized clinical trial