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Local Analgesia in Laparoscopy: A Randomized Trial

Jon I. Einarsson, MD, MPH^*, Judy Sun, MD^*, John Orav, PhD and Amy E. Young, MD^*

From the *Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts.

Address reprint requests to: Jon Ivar Einarsson, MD, Baylor College of Medicine, Department of Obstetrics and Gynecology, 6550 Fannin, Suite 901, Houston, TX 77030; e-mail: jonivar{at}yahoo.com.

OBJECTIVE: To investigate whether local infiltration of bupivacaine reduces postoperative pain at trocar sites during gynecologic laparoscopy.

METHODS: This was a randomized, placebo-controlled, double-blind clinical trial, using patients as their own controls. For each patient, 2 opposite trocar sites were infiltrated. One site was randomly chosen to receive 0.5% bupivacaine, and the other received 0.9% saline. In addition, patients were randomized into 2 cohorts to receive either preincision or postsurgical infiltration. Surgeons, patients, and interviewers were blinded toward the exposure. Postoperative pain was evaluated at 1 hour, 4 hours, and 24 hours after surgery using a 100-mm visual analog scale. Patients rated their pain at each of the infiltrated trocar sites. A 20-mm difference between pain scores was considered clinically significant. A paired t test was used for analysis.

RESULTS: Infiltration of bupivacaine at completion of surgery resulted in significantly decreased pain at 1 hour postoperatively (mean pain score 25.8 versus 48.6, P = .02). Mean pain scores at 4 hours and 24 hours were decreased, but not statistically different. Patients receiving bupivacaine before surgery did not have a statistically significant decrease in pain scores.

CONCLUSION: Infiltration of bupivacaine at completion of gynecologic laparoscopic surgery decreases pain at trocar sites in the immediate postoperative period.

LEVEL OF EVIDENCE: I

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