TOPLINE

Among patients with severe obesity who underwent laparoscopic bariatric surgery, weight-adjusted intraperitoneal instillation of a 0.2% bupivacaine significantly reduced postoperative pain scores. The analgesic benefit was confined to the early postoperative period; pain scores and analgesic requirements were similar between groups by 4 and 24 hours.

METHODOLOGY

• Postoperative pain after laparoscopic bariatric procedures is a major concern. Adequate pain control can speed recovery, lower the risk for complications, and reduce opioid requirements.
• In this randomized trial, researchers evaluated the efficacy of intraperitoneal instillation of 0.2% bupivacaine in 90 patients with severe obesity (mean age, 35.4 years; 78.7% women; mean preoperative BMI, 48.8) who underwent laparoscopic bariatric surgery under general anesthesia.
• At the end of surgery, the bupivacaine group received 0.5 mL/kg of 0.2% solution (1 mg/kg total dose) applied over the esophageal hiatus and in both subdiaphragmatic spaces, whereas the control group did not receive intraperitoneal bupivacaine.
• For postoperative pain management, patients received 2 g of paracetamol on arrival in recovery and then 1 g of paracetamol every 8 hours, with nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids added as needed.
• Pain was assessed using the visual analog scale (VAS; 0 = no pain; 10 = worst possible pain) at recovery and at 2, 4, and 24 hours postoperatively; other outcomes included using postoperative analgesics and antiemetics until discharge.

TAKEAWAY

• The bupivacaine group had significantly lower average VAS scores than the control group at recovery (2.2 vs 4.5) and at 2 hours (2.7 vs 4.1; P < .001 for both).
• VAS scores at 4 and 24 hours after surgery did not differ significantly between groups.
• Most patients (91.1%) required NSAIDs and/or opioids postoperatively, and more than two thirds needed antiemetics for postoperative nausea and vomiting.
• The requirements for analgesics and antiemetics were similar between groups; no statistically significant differences were observed in the overall need for NSAIDs or opioids, the number of analgesic medications used, or the use of antiemetics.

IN PRACTICE

“These findings suggest that while IPILA [intraperitoneal instillation of local anesthetic] does not replace systemic analgesics, it can enhance early pain control and potentially improve patient comfort during the critical recovery phase,” the authors of the study wrote.

SOURCE

The study was led by Sherif-Abd AlSayed Abd AlRahman Taie, Faculty of Medicine, Cairo University, Cairo, Egypt. It was published online in Obesity Surgery.

LIMITATIONS

The study was limited by its relatively small sample size. To maintain surgical visibility, the researchers used higher insufflation and pressure values (10 L/min at 14 mm Hg) — a potential trade-off they acknowledged. In addition, pain perception is inherently subjective and varies among individuals.

DISCLOSURES

Open-access funding was provided by the Science, Technology & Innovation Funding Authority in cooperation with the Egyptian Knowledge Bank. The authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.