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

Document Type : Original Article


1 Assistant Professor of Surgery, Fellowship of colorectal surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

2 Associate Professor of Anesthesia, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Resident of Anesthesiology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran

4 Resident of General Surgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran


Background: 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.
Methods: 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.
Results: 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).
Conclusion: Intraperitoneal lavage with bupivacaine during the operation reduced post-operative total narcotics use in patients who underwent laparoscopic proctectomy, not in rectopexy.


Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Medicine 2010; 11(12):1859-71.
Strassels SA, McNicol E, Wagner AK, Rogers WH, Gouveia WA, Carr DB. Persistent postoperative pain, health-related quality of life, and functioning 1 month after hospital discharge. Acute Pain 2004; 6(3-4):95-104.
Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. The Journal of the American Society of Anesthesiologists 1995; 82(6):1474-506.
Wu CL, Fleisher LA. Outcomes research in regional anesthesia and analgesia. Anesthesia & Analgesia 2000; 91(5):1232-42.
Wills VL, Hunt DR. Pain after laparoscopic cholecystectomy. BJS 2000; 87(3):273-84.
Cali RL, Meade PG, Swanson MS, Freeman C. Effect of morphine and incision length on bowel function after proctectomy. Diseases of the Colon & Rectum 2000; 43(2):163-8.
Louizos AA, Hadzilia SJ, Leandros E, Kouroukli IK, Georgiou LG, Bramis JP. Postoperative pain relief after laparoscopic cholecystectomy: a placebo-controlled double-blind randomized trial of preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25%. Surg Endosc 2005; 19(11):1503-6.
Hein A, Rösblad P, Gillis‐Haegerstrand C, Schedvins K, Jakobsson J, Dahlgren G. Low dose intrathecal morphine effects on post‐hysterectomy pain: a randomized placebo‐controlled study. Acta Anaesthesiologica Scandinavica 2012; 56(1):102-9.
Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990–1999. The Journal of the American Society of Anesthesiologists 2004; 101(4):950-9.
Kahokehr A, Sammour T, Soop M, Hill AG. Intraperitoneal local anaesthetic in abdominal surgery–a systematic review. ANZ Journal of Surgery 2011; 81(4):237-45.
Kehlet H, Liu SS. Continuous local anesthetic wound infusion to improve postoperative outcomeback to the periphery? Anesthesiology 2007; 107(3):369-71.
Khan MR, Raza R, Zafar SN, Shamim F, Raza SA, Pal KM, et al. Intraperitoneal lignocaine (lidocaine) versus bupivacaine after laparoscopic cholecystectomy: results of a randomized controlled trial. Journal of Surgical Research 2012; 178(2):662-9.
Ebrahimifard F, Nooraei N. Postoperative pain after laparoscopic cholecystectomy: a randomized clinical trial comparing intraperitoneal bupivacaine versus intravenous pethidine. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2013; 23(1):88-92.
Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish JP, Cohen NH, Young WL. Anesthesia. 8th ed. USA: Saunders; 2015.
Butala BP, Shah VR, Nived K. Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries. Saudi Journal of Anaesthesia 2013; 7(1):18-23.
Marks JL, Ata B, Tulandi T. Systematic review and metaanalysis of intraperitoneal instillation of local anesthetics for reduction of pain after gynecologic laparoscopy. Journal of Minimally Invasive Gynecology 2012; 19(5):545-53.
Lloyd GM, Kirby R, Hemingway DM, Keane FB, Miller AS, Neary P. The RAPID protocol enhances patient recovery after both laparoscopic and open colorectal resections. Surg Endosc 2010; 24(6):1434-9.
Joris J, Thiry E, Paris P, Weerts J, Lamy M. Pain after laparoscopic cholecystectomy: characteristics and effect of intraperitoneal bupivacaine. Anesthesia & Analgesia 1995; 81(2):379-84.
Steele SR, Brown TA, Rush RM, Martin MJ. Laparoscopic vs open proctectomy for colon cancer: results from a large nationwide population-based analysis. J Gastrointest Surg 2008; 12(3):583-91.
Koopmann MC, Harms BA, Heise CP. Money well spent: a comparison of hospital operating margin for laparoscopic and open colectomies. Surgery 2007; 142(4):546-53.
Guller U, Jain N, Hervey S, Purves H, Pietrobon R. Laparoscopic vs open proctectomy: outcomes comparison based on large nationwide databases. Arch Surg 2003; 138(11):1179-86.
Delaney CP, Chang E, Senagore AJ, Broder M. Clinical outcomes and resource utilization associated with laparoscopic and open proctectomy using a large national database. Ann Surg 2008; 247(5):819-24.
Adamina M, Kehlet H, Tomlinson GA, Senagore AJ, Delaney CP. Enhanced recovery pathways optimize health outcomes and resource utilization: a meta-analysis of randomized controlled trials in colorectal surgery. Surgery 2011; 149(6):830-40.
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G, Clinical Outcomes of Surgical Therapy (COST) Study Group. Short-term quality-of-life outcomes following laparoscopic-assisted proctectomy vs open proctectomy for colon cancer: a randomized trial. JAMA 2002; 287(3):321-8.
Chakravarty N, Singhai S, Shidhaye RV. Evaluation of intraperitoneal bupivacaine for postoperative analgesia in patients undergoing laparoscopic cholecystectomy: a prospective randomized trial. Anaesth Pain & intensive Care 2014; 18(4):361-6.
Kahokehr A, Sammour T, Zargar-Shoshtari K, Taylor MH, Hill AG. Intraperitoneal local anesthetic improves recovery after colon resection: a double-blinded randomized con- trolled trial. Annals of Surgery 2011; 254(1):28-38.
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(5):637-56.
Di Pace MR, Cimador M, Catalano P, Caruso A, Sergio A, Casuccio A, et al. Efficacy of periportal infiltration and intraperitoneal instillation of ropivacaine after laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A 2009; 19(6):821-5.
El Basha S, Hanna MG, Soaida SM, Refaee HH. Intraperitoneal instillation of l- bupivacaine in laparo- scopic pediatric procedures: a randomized-controlled study. Ain-Shams J Anaesthesiol 2015; 8:247-51.
Galante D. The laparoscopic oncologic surgical pathology and postoperative pain management through intraperitoneally local anesthetic in pediatric patients. Pediatr Blood Cancer 2014; 61:S243-4.
Hamill JK, Liley A, Hill AG. Intraperitoneal Local Anesthetic for Laparoscopic Appendectomy in Children: A Randomized Controlled Trial. Ann Surg. 2017 Jul; 266(1):189-194
Raman S, Lin M, Krishnan N. Systematic review and meta-analysis of the efficacy of liposomal bupivacaine in colorectal resections. J Drug Assess 2018; 7(1):43-50.
Stuhldreher JM, Adamina M, Konopacka A, Brady K, Delaney CP. Effect of local anesthetics on postoperative pain and opioid consumption in laparoscopic colorectal surgery. Surg Endosc 2012; 26(6):1617-23.
Jain S, Nazir N, Singh S, Sharma S. A prospective randomised controlled study for evaluation of high-volume low-concentration intraperitoneal bupivacaine for post-laparoscopic cholecystectomy analgesia. Indian J Anaesth 2018; 62(2):109-14.
Toleska M, Kartalov A, Kuzmanovska B, Panovski M, Shosholcheva M, Dimitrovski A, et al. Efficacy of intraperitoneal bupivacaine on pain relief after laparoscopic cholecystectomy. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2018; 39(1):123-9.
Yari M, Rooshani B, Golfam P, Nazari N. Intraperitoneal bupivacaine effect on postoperative nausea and vomiting following laparoscopic cholecystectomy. Anesth Pain Med 2014; 4(3):e16710.
Ghorbani-Abdehgah A, Jafari M, Molavi B, Shojaiefard A, Nasiri S, Yaghoobi Notash Jr A, et al. Postoperative pain relief following bupivacaine injection in sites & intraperitoneal spray of laparoscopic cholecystectomy. Journal of Pharmaceutical Research International 2017; 19(4).