Intraperitoneal Lavage with Bupivacaine 0.2% and Post-operative Pain in Laparoscopic Colorectal Surgery: A Prospective, Double-Blind, Randomized Controlled Trial

Local anesthetics have been proven as a method to reduce postoperative pain and opioid use. It reduces side effects associated with drug use and may improve patient health and reduce hospital length of stay. The aim of this study was to evaluate the effect of intraperitoneal bupivacaine on post-operative pain in laparoscopic colorectal surgery.
In this prospective randomized control trial, 63 patients aged 20-70 years candidates for laparoscopic proctectomy or rectopexy surgery, were divided into two groups. In the case group, anastomosis site was washed with 50 mL of bupivacaine 0.2% intraperitoneally. In the control group, equal volume of normal saline was used as placebo. Intravenous autofuser pain control filled with 3 g paracetamol was considered for all patients. Visual analogue scale (VAS) was recorded at 2, 8, 24 hours and narcotic usage was recorded totally for the first 24 hours after the operation.
There was no significant difference between pain scores according to the VAS criteria at 2, 8, and 24 hours after the operation in the case and control groups (P>0.05). Total pethidine consumption during the first 24 hours after the operation was lower in the bupivacaine group (49.03 ± 45.77) compared to the control group (77.74 ± 63.50), but the difference was not significant (P>0.05). However, the total dose of pethidine used after 24 hours after proctectomy (not rectopexy) was significantly lower in the bupivacaine group than that in the control group (P<0.05).
Intraperitoneal lavage with bupivacaine during the operation reduced post-operative total narcotics use in patients who underwent laparoscopic proctectomy, not in rectopexy.