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EDITORIAL
Year : 2013 | Volume
: 7
| Issue : 1 | Page : 5
Intraperitoneal local anesthetic for postoperative pain
Arman Kahokehr
Department of Surgery, Northland District Health Board, Whangarei Hospital, NewZealand
Correspondence Address:
Arman Kahokehr
Department of Surgery, Northland District Health Board, Whangarei Hospital
NewZealand
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1658-354X.109554
| Date of Web Publication | 30-Mar-2013 |
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How to cite this article:
Kahokehr A. Intraperitoneal local anesthetic for postoperative pain. Saudi J Anaesth 2013;7:5 |
Intraperitoneal local anesthetic (IPLA) has become an important addition for postoperative pain in the era of modern surgery. The method of delivering local anesthetic directly to the intraperitoneal cavity was first described in 1951 by Griffin et al. [1] However, this method was forgotten for decades until its implementation in minimal access surgery was rekindled. Based on level A evidence it is now accepted that IPLA significantly reduces postoperative pain and opiod use after laparoscopic general surgical procedures, [2],[3] open hysterectomy, [4] and laparoscopic gynecological procedures. [5] Various drugs, doses, and methods have been utilized. In this current issue, in a well-conducted double-blind trial, we observe the effect of combining IPLA and morphine to significantly reduce pain outcomes in women undergoing laparoscopic gynecological procedures (ref. present study).
There are several mechanisms of IPLA that have been postulated. IPLA is likely to blockade free afferent nerve endings in the peritoneum. Systemic absorption of local anesthetic from the peritoneal cavity may also play a part in reduced nociception although this would be expected to occur after any local anesthetic technique. Systemic levels of local anesthetic are detectable in the serum circulation as soon as 2 min after bolus instillation into the peritoneum [6] and a systematic review has recently confirmed that low-dose intravenous local anesthetic infusion is advantageous when compared to parenteral opioids alone in patients having abdominal operations. [7] It is also known that local anesthetics have anti-inflammatory actions. [8]
With this evidence in mind, it is hoped that surgeons and anesthetists will seriously consider the instillation of IPLA as part of multimodal analgesia.
| References | |  |
| 1. | Griffin EM, Prystowsky H, Hingson RA. The use of topical anaesthesia of the peritoneum in poor risk surgery and in augmenting inadequate vertebral conduction anaesthesia. N Z Med J 1951;50:31-3. 
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| 2. | Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal use of local anesthetic in laparoscopic cholecystectomy: Systematic review and metaanalysis of randomized controlled trials. J Hepatobiliary Pancreat Sci 2010;17:637-56.
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| 3. | Kahokehr A, Sammour T, Srinivasa S, Hill AG. Systematic review and meta-analysis of intraperitoneal local anaesthetic for pain reduction after laparoscopic gastric procedures. Br J Surg 2011;98:29-36.
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| 4. | Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawal N. Postoperative pain after abdominal hysterectomy: A double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg 2004;99:1173-9.
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| 5. | Sripada S, Roy S, Mathur M, Hamilton M, Cranfield K, Bhattacharya S. A prospective double-blind randomised controlled trial of intraoperative pelvic instillation with bupivacaine for management of pain following laparoscopy and dye. BJOG 2006;113:835-8.
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| 6. | Fuhrer Y, Charpentier C, Boulanger G, Menu N, Grosdidier G, Laxenaire MC. Analgesia after laparoscopic cholecystectomy by intraperitoneal administration of bupivacaine. Ann Fr Anesth Reanim 1996;15:128-34.
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| 7. | Marret E, Rolin M, Beaussier M, Bonnet F. Meta-analysis of intravenous lidocaine and postoperative recovery after abdominal surgery. Br J Surg 2008;95:1331-8.
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| 8. | Mac Gregor RR, Thorner RE, Wright DM. Lidocaine inhibits granulocyte adherence and prevents granulocyte delivery to inflammatory sites. Blood 1980;56:203-9.
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