The Use of Intraperitoneal Bupivacaine in Laparoscopic Roux-en-Y Gastric Bypass: a Double-blind, Randomized Controlled Trial

  • Iris E. SchipperEmail author
  • Manon Schouten
  • Tugba Yalcin
  • Gijs D. Algie
  • Stefan L. Damen
  • Robert M. Smeenk
  • Ruben Schouten
Original Contributions



Several studies have shown a reduction in postoperative pain and length of hospital stay when using intraperitoneal local anesthetics during laparoscopic surgery. In morbidly obese patients, respiratory depression due to opioid use is a serious side effect. Any different type of analgesia is therefore clinically relevant.


To assess the effect of intraperitoneal bupivacaine on postoperative pain after laparoscopic Roux-en-Y gastric bypass (LRYGB).


Between March and November 2017, 130 patients were included and randomly assigned to receive 20 ml or 0 ml of 2.5% bupivacaine hydrochloride sprayed onto the diaphragm. Pain scores for abdominal and shoulder pain were conducted using the visual analogue scale (VAS) for pain score at 0, 1, 6, and 24 h postoperatively. The length of hospital stay and use of analgesics was recorded in digital patient records. The primary outcome is the pain scores and the secondary outcomes are postoperative use of opioids or antiemetics and length of hospital stay.


The study and control group contained respectively 66 and 61 patients. Patient characteristics were equal in both groups (p < 0.05), except for age. No significant reduction of postoperative pain or opioid use was seen with the use of intraperitoneal bupivacaine. There was also no significant reduction in the use of antiemetics and length of hospital stay.


The use of intraperitoneal bupivacaine in LRYGB does not show a statistically significant reduction in postoperative pain or postoperative opioid use. Therefore, using intraperitoneal bupivacaine has no clinical relevance and should no longer be used in LRYGB.


Obesity Laparoscopic Roux-en-Y gastric bypass Intraperitoneal bupivacaine Postoperative pain 



We would like to thank Dr. Scott A. Shikora for inviting us to present this paper during the “top 10 papers session” at the 23rd world congress of the international federation for the surgery of obesity and metabolic disorders (IFSO) in Dubai in September 2018.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This prospective, double-blind, randomized controlled trial was approved by the medical ethical committee in August 2016.

Informed Consent

Informed consent was obtained from all individual participants included in this study.


  1. 1. [Internet] Denmark: World Health Organization/Europe approaches to obesity; c1948-2019 [cited 2018 July 15]. Available from:
  2. 2.
    Lehnert T, Sonntag D, Konnopka A, et al. Economic costs of overweight and obesity. Best Pract Res Clin Endocrinol Metab. 2013;27(2):105–15.CrossRefGoogle Scholar
  3. 3.
    Alsumali A, Al-Hawag A, Samnaliev M, et al. Systematic assessment of decision analytic models for the cost-effectiveness of bariatric surgery for morbid obesity. Surg Obes Relat Dis. 2018;14(7):1041–59.CrossRefGoogle Scholar
  4. 4.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.CrossRefGoogle Scholar
  5. 5.
    Butala BP, Shah VR, Nived K. Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries. Saudi J Anaesth. 2013;7(1):18–23.CrossRefGoogle Scholar
  6. 6.
    Coblijn UK, Lagarde SM, de Castro SMM, et al. Symptomatic marginal ulcer disease after Roux-en-Y gastric bypass: incidence, risk factors and management. Obes Surg. 2015;25(5):805–11.CrossRefGoogle Scholar
  7. 7.
    Upadya M, Pushpavathi SH, Seetharam KR. Comparison of intra-peritoneal bupivacaine and intravenous paracetamol for postoperative pain relief after laparoscopic cholecystectomy. Anesth Essays Res. 2015;9(1):39–43.Google Scholar
  8. 8.
    Das NT, Deshpande C. Effects of intraperitoneal local anaesthetics bupivacaine and ropivacaine versus placebo on postoperative pain after laparoscopic cholecystectomy: a randomised double blind study. J Clin Diagn Res. 2017;11(7):UC08–12.Google Scholar
  9. 9.
    Kahokehr A, Sammour T, Soop M, et al. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci. 2010;17(5):637–56.CrossRefGoogle Scholar
  10. 10.
    Mraović B, Jurisić T, Kogler-Majeric V, et al. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 1997;41(2):193–6.CrossRefGoogle Scholar
  11. 11.
    Castillo-Garza G, Díaz-Elizondo JA, Cuello-García CA, et al. Irrigation with bupivacaine at the surgical bed for postoperative pain relief after laparoscopic cholecystectomy. JSLS. 2012;16(1):105–11.CrossRefGoogle Scholar
  12. 12.
    Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy: a randomized clinical trial comparing intraperitoneal bupivacaine versus intravenous pethidine. Surg Laparosc Endosc Percutan Tech. 2013;23(1):88–92.CrossRefGoogle Scholar
  13. 13.
    Stacy Lao L, Torillo ML, Pepito P, et al. Efficacy of intraperitoneal bupivacaine on postoperative analgesia in laparoscopic cholecystectomy: a meta-analysis. J Am Coll Surg. 2017;225(4):e85.Google Scholar
  14. 14.
    Symons JL, Kemmeter PR, Davis AT, et al. A double-blinded, prospective randomized controlled trial of intraperitoneal bupivacaine in laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg. 2007;204(3):392–8.CrossRefGoogle Scholar
  15. 15.
    Ruiz-Tovar J, Gonzalez J, Garcia A, et al. Intraperitoneal ropivacaine irrigation in patients undergoing bariatric surgery: a prospective randomized clinical trial. Obes Surg. 2016;26(11):2616–21.CrossRefGoogle Scholar
  16. 16.
    Alamdari NM, Bakhtiyari M, Gholizadeh B, et al. Analgesic effect of intraperitoneal bupivacaine hydrochloride after laparoscopic sleeve gastrectomy: a randomized clinical trial. J Gastrointest Surg. 2018;22(3):396–401.CrossRefGoogle Scholar
  17. 17.
    Batinac T, Sotošek Tokmadžić V, Peharda V, et al. Adverse reactions and alleged allergy to local anesthetics: analysis of 331 patients. J Dermatol. 2013;40(7):522–7.CrossRefGoogle Scholar
  18. 18. [Internet] Diemen: Zorginstituut Nederland Medicines Pricing; c2019 [cited 2018 July 16] Available from:
  19. 19.
    Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2013;23(1):88–92.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryFlevoziekenhuisAlmereThe Netherlands
  2. 2.Vrije Universiteit AmsterdamAmsterdamThe Netherlands
  3. 3.Bravis HospitalRoosendaalThe Netherlands
  4. 4.Medical Center LeeuwardenLeeuwardenThe Netherlands
  5. 5.Albert Schweitzer HospitalDordrechtThe Netherlands

Personalised recommendations