Intraoperative Bupivacaine Intra-Abdominal Infiltration for Laparoscopic Gynaecological Procedures

Introduction: Laparoscopy in gynaecology is now widely practiced along with multimodal analgesia for postoperative pain. Intra-peritoneal infiltration of Bupivacaine is a novel method to enhance postoperative pain relief. This study was designed to explore the feasibility and effectiveness of intra-peritoneal Bupivacaine in laparoscopic gynaecological surgical procedures. Objectives: To compare pain scores, analgesic requirements, postoperative mobilisation, and patient satisfaction after intra-peritoneal infiltration of Bupivacaine and placebo in Laparoscopic gynaecology surgeries. Methodology: A double-blinded RCT was conducted at Teaching Hospital Peradeniya, Sri Lanka. Two groups were used. One was “therapeutic laparoscopic procedures,” and the other was “diagnostic laparoscopic procedures”. Cases were subjected to intra-peritoneal infiltration of Bupivacaine after the procedures. Distilled water was used as the placebo. Recruitment of subjects was voluntary with informed written consent. Randomization was accomplished using the sealed envelopes technique. Postoperative pain scores, analgesic requirement, mobilization, and overall patient satisfaction were assessed, and SPSS®VER.21 was used for data analysis. Results: 49 & 46 patients were included in cases and control groups, respectively. Significantly lower pain score on postoperative day 2 (p = 0.004) and less amount of per-rectal Diclofenac (p = 0.014) requirement was noted with IP-Bupivacaine in the diagnostic laparoscopy arm. Similar to that, 6-hour post-op pain (p = 0.033), IM Pethidine usage (p = 0.036), oral Paracetamol (p = 0.007), and duration for full mobility (p = 0.01) was significantly improved in therapeutic laparoscopy arm with IP Bupivacaine. No Bupivacaine-related major or minor toxicity was reported. Conclusion: IP Bupivacaine reduces postoperative pain and non-opioid analgesic requirements in diagnostic laparoscopy procedures. Immediate postoperative pain, both opioid/non-opioid requirements were less in therapeutic laparoscopic surgeries, along with enhanced postoperative mobilization with IP Bupivacaine.