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
