Preemptive Local Anesthetic in Gynecologic Laparoscopy and Postoperative Movement-Evoked Pain: A Randomized Trial

Abstract

Study objective: To evaluate whether preemptive local anesthetics injected into the trocar areas reduce postoperative movement-evoked pain within an enhanced recovery program (ERP) in laparoscopic gynecologic surgery.

Design: A randomized and double-blinded trial with parallel assignments (Canadian Task Force Classification I).

Setting: The study was conducted in the gynecologic department at the University Hospital of Stavanger, Stavanger, Norway.

Patients: Twenty-four women eligible for elective laparoscopic surgery for a benign indication within an ERP were included.

Interventions: The women were randomized to preemptive local injections of either 0.5% bupivacaine (intervention group) or 0.9% saline (control group) at each trocar site.

Measurements and main results: The primary outcome measure of the study was movement-evoked pain 5 hours after surgery. The secondary outcome measures were pain at rest 2 and 5 hours after surgery and the use of rescue analgesics during the postoperative period. Pain was measured on a numeric rating scale of 0 to 10. Data were treated to a per-protocol analysis, and a p < .05 was considered significant.

Results: Twenty-three women completed the trial. The median score for movement-evoked pain 5 hours after surgery was significantly lower in the intervention group (1 vs. 3, p = .044). There was no difference in pain at rest after 2 and 5 hours and no difference in the requirement for rescue analgesics.

Conclusion: Preemptive local anesthetics in the trocar areas are shown to be beneficial in laparoscopic gynecologic surgery within an enhanced recovery program. Movement-evoked pain is far more intense than pain at rest.

Keywords: Enhanced recovery program; Laparoscopy; Movement-evoked pain; Postoperative pain; Preemptive local anesthetic.