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Prophylactic ip injection of bupivacaine and/or morphine does not improve postoperative analgesia after laparoscopic gynecologic surgery

[L’injection intrapéritonéale préventive de bupivacaïne et/ou de morphine n’améliore pas l’analgésie postopératoire après une intervention gynécologique laparoscopique]

Hawa Keita, MD PhD^*, Jean Louis Benifla, MD, Violaine Le Bouar, Raphaël Porcher, MD PhD, Bogena Wachowska, MD^*, Karima Bedairia, MD^*, Jean Mantz, MD PhD^* and Jean Marie Desmonts, MD^*

^* From the Departments of Anesthesiology,
Gynecology, and
Pharmacy, Hospital Bichat; and
the Department of Biostatistics, Hospital Saint-Louis, Paris, France.

Address correspondence to: Dr. Hawa Keita, Department of Anesthesiology and Intensive Care, Hospital Bichat, 46 rue Henri Huchard, 75018 Paris, France. Phone: 33-1-40-25-81-16; Fax: 33-1-42-28-99-96; E-mail: hawakeita{at}club-internet.fr

Purpose: To determine the effectiveness of ip bupivacaine and/or morphine for postoperative analgesia after laparoscopic surgery. A controversy exists on the effectiveness and clinical value of ip injection of local anesthetics for postoperative analgesia. A possible peripheral analgesic effect of morphine after ip injection remains debated as well.

Methods: We conducted a randomized, double-blinded, study to compare the efficacy of prophylactic ip administration of 0.9% saline (n = 16), 0.5% bupivacaine (100 mg, n = 15), morphine (3 mg, n = 16) and a mixture with 0.5% bupivacaine (100 mg) and morphine (3 mg, n = 18) to reduce both postoperative pain scores and analgesic requirements after gynecologic laparoscopic surgery. A multimodal analgesia regimen (acetaminophen, nonsteroidal anti-inflammatory drugs and morphine) was used for postoperative analgesia.

Results: No difference was observed in postoperative pain scores (visual analogue scale at rest and on coughing), or analgesic requirements during the first 24 postoperative hours between the four groups. There was also no significant intergroup difference in sedation scores and incidence of nausea and vomiting.

Conclusion: When multimodal postoperative analgesia is used, prophylactic ip administration of 100 mg bupivacaine and/or 3 mg morphine does not significantly improve postoperative analgesia in patients undergoing laparoscopic gynecologic surgery.