Ann Surg Treat Res.  2020 Feb;98(2):96-101. 10.4174/astr.2020.98.2.96.

Effect of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy: double-blind randomized study

• Ha HK
• Lee KG
• Choi KK
• Kim WS
• Cho HR

• KMID: 2469109
• DOI: http://doi.org/10.4174/astr.2020.98.2.96

Abstract

PURPOSE
Local anesthetics can decrease postoperative pain after appendectomy. This study sought to verify the efficacy of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy (SILA).
METHODS
Between March 2014 and October 2015, 68 patients with appendicitis agreed to participate in this study. After general anesthesia, patients were randomized to bupivacaine or control (normal saline) groups. The assigned drugs were infiltrated into subcutaneous tissue and deep into anterior rectus fascia. Postoperative analgesics use and pain scores were recorded using visual analogue scale (VAS) by investigators at 1, 8, and 24 hours and on day 7. All surgeons, investigators and patients were blinded to group allocation.
RESULTS
Thirty patients were allocated into the control group and 37 patients into bupivacaine group (one patient withdrew consent before starting anesthesia). Seven from the control group and 4 from the bupivacaine group were excluded. Thus, 23 patients in the control group and 33 in the bupivacaine group completed the study. Preoperative demographics and operative findings were similar. Postoperative pain and analgesics use were not different between the 2 groups. Subgroup analysis determined that VAS pain score at 24 hours was significantly lower in the bupivacaine group (2.1) than in the control group (3.8, P = 0.007) when surgery exceeded 40 minutes. During immediate postoperative period, bupivacaine group needed less opioids (9.1 mg) than control (10.4 mg).
CONCLUSION
Bupivacaine did not decrease pain and analgesics use. When surgery exceeded 40 minutes, bupivacaine use might be associated with less pain and less analgesics use.

Keyword

Appendicitis; Bupivacaine; Laparoscopy; Local anesthesia; Postoperative pain

MeSH Terms

Analgesics*
Analgesics, Opioid
Anesthesia, General
Anesthesia, Local
Anesthetics, Local
Appendectomy*
Appendicitis
Bupivacaine*
Demography
Fascia
Humans
Laparoscopy
Pain, Postoperative*
Postoperative Period
Research Personnel
Subcutaneous Tissue
Surgeons
Analgesics
Analgesics, Opioid
Anesthetics, Local
Bupivacaine

Reference

1. Wei B, Qi CL, Chen TF, Zheng ZH, Huang JL, Hu BG, et al. Laparoscopic versus open appendectomy for acute appendicitis: a metaanalysis. Surg Endosc. 2011; 25:1199–1208.

2. Wei HB, Huang JL, Zheng ZH, Wei B, Zheng F, Qiu WS, et al. Laparoscopic versus open appendectomy: a prospective randomized comparison. Surg Endosc. 2010; 24:266–269.

3. Buckley FP 3rd, Vassaur H, Monsivais S, Jupiter D, Watson R, Eckford J. Single-incision laparoscopic appendectomy versus traditional three-port laparoscopic appendectomy: an analysis of outcomes at a single institution. Surg Endosc. 2014; 28:626–630.

4. Frutos MD, Abrisqueta J, Lujan J, Abellan I, Parrilla P. Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy. Ann Surg. 2013; 257:413–418.

5. Teoh AY, Chiu PW, Wong TC, Poon MC, Wong SK, Leong HT, et al. A double-blinded randomized controlled trial of laparoendoscopic single-site access versus conventional 3-port appendectomy. Ann Surg. 2012; 256:909–914.

6. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH, et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012; 82:172–178.

7. Ahn SR, Kang DB, Lee C, Park WC, Lee JK. Postoperative pain relief using wound infiltration with 0.5% bupivacaine in single-incision laparoscopic surgery for an appendectomy. Ann Coloproctol. 2013; 29:238–242.

8. Cervini P, Smith LC, Urbach DR. The effect of intraoperative bupivacaine administration on parenteral narcotic use after laparoscopic appendectomy. Surg Endosc. 2002; 16:1579–1582.

9. Wright JE. Controlled trial of wound infiltration with bupivacaine for postoperative pain relief after appendicectomy in children. Br J Surg. 1993; 80:110–111.

10. Edwards TJ, Carty SJ, Carr AS, Lambert AW. Local anaesthetic wound infiltration following paediatric appendicectomy: a randomised controlled trial: time to stop using local anaesthetic wound infiltration following paediatric appendicectomy? Int J Surg. 2011; 9:314–317.

11. Jensen SI, Andersen M, Nielsen J, Qvist N. Incisional local anaesthesia versus placebo for pain relief after appendectomy in children--a double-blinded controlled randomised trial. Eur J Pediatr Surg. 2004; 14:410–413.

12. Ko CY, Thompson JE Jr, Alcantara A, Hiyama D. Preemptive analgesia in patients undergoing appendectomy. Arch Surg. 1997; 132:874–877.

13. Randall JK, Goede A, Morgan-Warren P, Middleton SB. Randomized clinical trial of the influence of local subcutaneous infiltration vs subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy. Colorectal Dis. 2010; 12:477–479.

14. Ke RW, Portera SG, Bagous W, Lincoln SR. A randomized, double-blinded trial of preemptive analgesia in laparoscopy. Obstet Gynecol. 1998; 92:972–975.

15. Khorgami Z, Shoar S, Hosseini Araghi N, Mollahosseini F, Nasiri S, Ghaffari MH, et al. Randomized clinical trial of subcutaneous versus interfascial bupivacaine for pain control after midline laparotomy. Br J Surg. 2013; 100:743–748.

16. Lacy CF, Armstrong LL, Goldman MP, Lace LL. Lexi-Comp's drug information handbook. 12th ed. Hudson (OH): Lexi-Comp, Inc.;2004. p. 1865.

17. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994; 56:217–226.

18. Molliex S, Haond P, Baylot D, Prades JM, Navez M, Elkhoury Z, et al. Effect of pre- vs postoperative tonsillar infiltration with local anesthetics on postoperative pain after tonsillectomy. Acta Anaesthesiol Scand. 1996; 40:1210–1215.

19. Dahl V, Raeder JC, Erno PE, Kovdal A. Pre-emptive effect of pre-incisional versus post-incisional infiltration of local anaesthesia on children undergoing hernioplasty. Acta Anaesthesiol Scand. 1996; 40:847–851.

20. Lohsiriwat V, Lert-akyamanee N, Rushatamukayanunt W. Efficacy of pre-incisional bupivacaine infiltration on postoperative pain relief after appendectomy: prospective double-blind randomized trial. World J Surg. 2004; 28:947–950.

21. Trescot AM, Datta S, Lee M, Hansen H. Opioid pharmacology. Pain Physician. 2008; 11:2 Suppl. S133–S153.

22. Meacham K, Shepherd A, Mohapatra DP, Haroutounian S. Neuropathic pain: central vs. peripheral mechanisms. Curr Pain Headache Rep. 2017; 21:28.

23. Hulley SB, Cummings SR, Browner WS, Grady DG, Newman TB. Designing clinical research: an epidemiologic approach. 4 ed. Philadelphia (PA): Lippincott Williams & Wilkins;2013.

24. Chahar P, Cummings KC 3rd. Liposomal bupivacaine: a review of a new bupivacaine formulation. J Pain Res. 2012; 5:257–264.

25. Hutchins J, Argenta P, Berg A, Habeck J, Kaizer A, Geller MA. Ultrasound-guided subcostal transversus abdominis plane block with liposomal bupivacaine compared to bupivacaine infiltration for patients undergoing robotic-assisted and laparoscopic hysterectomy: a prospective randomized study. J Pain Res. 2019; 12:2087–2094.