Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-10T20:01:05.570Z Has data issue: false hasContentIssue false
  • English
  • Français

Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy

Published online by Cambridge University Press:  11 July 2005

J. Hernández-Palazón ,
J. A. Tortosa ,
V. Nuño de la Rosa ,
J. Giménez-Viudes ,
G. Ramírez  and
R. Robles
J. Hernández-Palazón
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Anaesthesia, Murcia, Spain
J. A. Tortosa
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Anaesthesia, Murcia, Spain
V. Nuño de la Rosa
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Anaesthesia, Murcia, Spain
J. Giménez-Viudes
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Anaesthesia, Murcia, Spain
G. Ramírez
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Anaesthesia, Murcia, Spain
R. Robles
Affiliation:
Hospital Universitario ‘Virgen de la Arrixaca’, Department of Surgery, Murcia, Spain
Get access

Abstract

Summary

Background and objective: Intraperitoneal administration of a local anaesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported except after laparoscopic cholecystectomy. This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy.

Methods: At the end of laparoscopic cholecystectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally. There were 30 patients in each group: Group 1, physiological saline 30 mL; Group 2, bupivacaine 0.25% 30 mL; Group 3, bupivacaine 0.25% 30 mL plus morphine 2 mg. In addition, Group 2 received 2 mg intravenous (i.v.) morphine in 2 mL saline, and Groups 1 and 3, 2 mL saline intravenously. Patients' postoperative pain was evaluated using a visual analogue scale and a verbal rating score. The postoperative analgesic requirement was assessed by the total dose of metamizol administered by an i.v. patient-controlled analgesia (PCA) device. Pain, vital signs, supplemental analgesic consumption and side-effects were recorded for all patients for 24 h.

Results: There were no differences between the three groups regarding pain scores (at rest and coughing) during the study except in the first 2 h, when scores were lower for patients receiving intraperitoneal bupivacaine plus i.v. morphine (P < 0.05). Supplemental consumption of metamizol was significantly lower (P < 0.05) in Group 3 than in Group 1 during the first 6 h after surgery. However, the cumulative doses of metamizol were also lower in Group 2 than in Groups 1 and 3 over the entire study (2025 ± 1044 mg vs. 4925 ± 1238 and 4125 ± 1276 mg; P < 0.05).

Conclusions: In patients undergoing laparoscopic cholecystectomy, the intraperitoneal administration of morphine plus bupivacaine 0.25% reduced the analgesic requirements during the first 6 postoperative hours compared with the control group. However, the combination of intraperitoneal bupivacaine 0.25% and i.v. morphine was more effective for treatment of pain after laparoscopic cholecystectomy.

Keywords

ANAESTHETICS, LOCAL, bupivacaineOPIOIDS, morphinePOSTOPERATIVE PERIOD, painSURGERY, laparoscopic cholecystectomy
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 11 , November 2003 , pp. 891 - 896
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McMahon AJ, Russell IT, Ramsay G, et al. Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery 1994; 115: 533–539.Google Scholar
Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. Br J Surg 2000; 87: 273–284.Google Scholar
Narchi P, Benhamou D, Fernandez H. Intraperitoneal local anaesthetic for shoulder pain after day-case laparoscopy. Lancet 1991; 338: 1569–1570.Google Scholar
Helvacioglu A, Weis R. Operative laparoscopy and postoperative pain relief. Fertil Steril 1992; 57: 548–552.Google Scholar
Callesen T, Hjort D, Mogensen T, et al. Combined field block and i.p. instillation of ropivacaine for pain management after laparoscopic sterilization. Br J Anaesth 1999; 82: 586–590.Google Scholar
Goldstein A, Grimault P, Henique A, Keller M, Fortin A, Darai E. Preventing postoperative pain by local anesthetic instillation after laparoscopic gynecologic surgery: a placebo-controlled comparison of bupivacaine and ropivacaine. Anesth Analg 2000; 91: 403–407.Google Scholar
Schulte-Steinberg H, Weninger E, Jokisch D, et al. Intraperitoneal versus interpleural morphine or bupivacaine for pain after laparoscopic cholecystectomy. Anesthesiology 1995; 82: 634–640.Google Scholar
Colbert ST, Moran K, O'Hanlon DM, Chambers F, Moriarty DC, Blunnie WP. An assessment of the value of intraperitoneal meperidine for analgesia postlaparoscopic tubal ligation. Anesth Analg 2000; 91: 667–670.Google Scholar
Stein C. Peripheral mechanisms of opioid analgesia. Anesth Analg 1993; 76: 182–191.Google Scholar
Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med 1995; 332: 1685–1690.Google Scholar
Viel EJ, Bruelle P, Lalourcy L, Eledjam JJ. Perineural administration of opioids in combination with local anaesthetics. In: Van Zundert A, ed. Highlights in Pain Therapy and tegional Anaesthesia V. Barcelona, Spain: Permanyer, 1996: 235–240.
Kehlet H, Dahl JB. The value of ‘multimodal’ or ‘balanced analgesia’ in postoperative pain treatment. Anesth Analg 1993; 73: 1048–1056.Google Scholar
Moore A, Moore O, McQuay H, Gavaghan D. Deriving dichotomous outcome measures from continuous data in randomised controlled trials of analgesics: use of pain intensity and visual analogue scales. Pain 1997; 69: 311–315.Google Scholar
Manthra S, Thisted R, Foss J, Ellis JE, Roizen MF. A proposal to use confidence intervals for visual analog scale data for pain management to determine clinical significance. Anesth Analg 1993; 77: 1041–1047.Google Scholar
Collins KM, Docherty PW, Plantevin OM. Postoperative morbidity following gynaecological outpatient laparoscopy. A reappraisal of the service. Anaesthesia 1984; 39: 819–822.Google Scholar
Loughney AD, Sarma V, Ryall EA. Intraperitoneal bupivacaine for relief of pain following day case laparoscopy. Br J Obstet Gynaecol 1994; 101: 449–451.Google Scholar
Rademaker BM, Kalkman CJ, Odoom JA, de Wit L, Ringers J. Intraperitoneal local anaesthetics after laparoscopic cholecystectomy: effects on postoperative pain, metabolic responses and lung function. Br J Anaesth 1994; 72: 263–266.Google Scholar
Chundrigar T, Hedges AR, Morris R, Stamatakis JD. Intraperitoneal bupivacaine for effective pain relief after laparoscopic cholecystectomy. Ann R Coll Surg Engl 1993; 75: 437–439.Google Scholar
Mraovic B, Jurisic T, Kogler-Majeric V, Sustic A. Intraperitoneal bupivacaine for analgesia after laparoscopic cholecystectomy. Acta Anaesthesiol Scand 1997; 41: 193–196.Google Scholar
Szem JW, Hydo L, Barie PS. A double-blinded evaluation of intraperitoneal bupivacaine vs saline for the reduction of postoperative pain and nausea after laparoscopic cholecystectomy. Surg Endosc 1996; 10: 44–48.Google Scholar
Weber A, Muñoz J, Garteiz D, Cueto J. Use of subdiaphragmatic bupivacaine instillation to control postoperative pain after laparoscopic surgery. Surg Laparosc Endosc 1997; 7: 6–8.Google Scholar
Pasqualucci A, de Angelis V, Contardo R, et al. Preemptive analgesia: intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study. Anesthesiology 1996; 85: 11–20.Google Scholar
Tsimoyiannis EC, Glantzounis G, Lekkas ET, Siakas P, Jabarin M, Tzourou H. Intraperitoneal normal saline and bupivacaine infusion for reduction of postoperative pain after laparoscopic cholecystectomy. Surg Laparosc Endosc 1998; 8: 416–420.Google Scholar
Moiniche S, Jorgensen H, Wetterslev J, Dahl JB. Local anesthetic infiltration for postoperative pain relief after laparoscopy: a qualitative and quantitative systematic review of intraperitoneal, port-site infiltration and mesosalpinx block. Anesth Analg 2000; 90: 899–912.Google Scholar
Labaille T, Mazoit JX, Paqueron X, Franco D, Benhamou D. The clinical efficacy and pharmacokinetics of intraperitoneal ropivacaine for laparoscopic cholecystectomy. Anesth Analg 2002; 94: 100–105.Google Scholar
Torres LM, Rodríguez MJ, Montero A, et al. Efficacy and safety of dipyrone versus tramadol in the management of pain after hysterectomy: a randomized, double-blind, multicenter study. Reg Anesth Pain Med 2001; 26: 118–124.Google Scholar
Power I, Brown DT, Wildsmith JA. The effect of fentanyl, meperidine and diamorphine on nerve conduction in vitro. Reg Anesth 1991; 16: 204–208.Google Scholar
Armstrong PJ, Morton CP, Nimmo AF. Pethidine has a local anaesthetic action on peripheral nerves in vivo. Addition to prilocaine 0.25% for intravenous regional anaesthesia in volunteers. Anaesthesia 1993; 48: 382–386.Google Scholar
Stein C, Hassan AH, Przewlocki R, Gramsch C, Peter K, Herz A. Opioids from immunocytes interact with receptors on sensory nerves to inhibit nociception in inflammation. Proc Natl Acad Sci USA 1990; 87: 5935–5939.Google Scholar
Hassan AH, Ableitner A, Stein C, Herz A. Inflammation of the rat paw enhances axonal transport of opioid receptors in the sciatic nerve and increases their density in the inflamed tissue. Neuroscience 1993; 55: 185–195.Google Scholar
Antonijevic I, Mousa SA, Schafer M, Stein C. Perineurial defect and peripheral opioid analgesia inflammation. J Neurosci 1995; 15 (Pt 1): 165–172.Google Scholar
Olsson Y. Microenvironment of the peripheral nervous system under normal and pathological conditions. Crit Rev Neurobiol 1990; 5: 265–311.Google Scholar
Ng A, Smith G. Intraperitoneal administration of analgesia: is this practice of any utility? Br J Anaesth 2002; 89: 535–537.Google Scholar