The Use of Intraperitoneal Bupivacaine in Laparoscopic Roux-en-Y Gastric Bypass: a Double-blind, Randomized Controlled Trial
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.
KeywordsObesity 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.
This prospective, double-blind, randomized controlled trial was approved by the medical ethical committee in August 2016.
Informed consent was obtained from all individual participants included in this study.
- 1.euro.who.int [Internet] Denmark: World Health Organization/Europe approaches to obesity; c1948-2019 [cited 2018 July 15]. Available from: www.euro.who.int/en/health-topics/noncommunicable-diseases/obesity/obesity.
- 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.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
- 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
- 18.medicijnkosten.nl [Internet] Diemen: Zorginstituut Nederland Medicines Pricing; c2019 [cited 2018 July 16] Available from: www.medicijnkosten.nl/databank?zoekterm=bupivacaine.