Peritoneal local anesthetic during diagnostic laparoscopy - Tips from Other Journals

Date: May, 1992

Shoulder pain occurs in up to 63 percent of patients following diagnostic laparoscopy. This pain may be related to residual carbon dioxide in the abdominal cavity. Narchi and colleagues designed a study to assess the effectiveness of intraperitoneal local anesthetic in reducing the severity and duration of shoulder pain following diagnostic laparoscopy.

Eighty patients were randomly assigned to four comparable groups. Two groups acted as controls, which included 20 women who received no intraperitoneal administration and 20 women who received 80 mL of saline injected in the right subdiaphragmatic area. The third and fourth groups received 80 mL of local anesthetic solution in the right subdiaphragmatic area at the beginning of the procedure. The women in the third group received 0.5 percent lidocaine with adrenaline, and women in the fourth group received 0.125 percent bupivacaine with adrenaline. Shoulder pain was assessed by a visual analog pain scale and requirements for analgesia during the 48 hours following surgery.

No significant differences in pain scores were found between the two control groups or between the two treatment groups. Therefore, the combined results from the control and treatment groups were compared. Mean shoulder pain scores at eight, 12, 24, 36 and 48 hours after surgery were significantly lower in patients receiving local anesthetic than in patients in the control groups. In addition, more patients in the local anesthesia groups reported being completely free from pain than patients in the control groups (63 percent versus 33 percent). No significant differences in other symptoms, such as lower abdominal pain and nausea, were found between the groups. No side effects were observed in any patients.

The study findings demonstrate that the common complication of shoulder pain following diagnostic laparoscopy can be prevented by the routine use of local anesthetic instilled into the upper peritoneum at the beginning of the procedure. (Lancet, December 21/28, 1991, vol. 338, p. 1569. )

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