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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

Abstract

Background

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.

Objective

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

Methods

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.

Results

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.

Conclusion

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.

Keywords

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

Notes

Acknowledgments

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.

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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

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