تاثير انفليتراسيون موضعي و داخل صفاقي داروهاي بي حس كننده موضعي براي كاهش درد بعد از عمل لاپاروسكوپي تشخيص زنان

Effect of Local and Intraperitoneal Infiltration of Local Anesthetics on Pain Relief after Laparoscopic Gynecologic Examinations

Background and Objectives: Pain after laparoscopy results from the stretching of the intraabdominal cavity, peritoneal infiltration, and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Proper postoperative analgesia is essential in facilitating early mobilization and discharge in these patients. One way to achieve this objective might be to infiltrate local anesthetics in the surgical field before surgery, attempting to capitalize on a pre-emptive analgesic effect. This study was performed to evaluate the efficacy of presurgical local infiltration of bupivacaine and intraperitoneal subdiaphragmatic instillation of lidocaine and to minimize postoperative pain after diagnostic gynecologic laparoscopy under general anesthesia. Materials and Methods: In the prospective, double - blind randomized study, 32 female patients with a history of infertility scheduled for diagnostic laparoscopy underwent general anesthesia. In the treatment group A patients (n=17) were infiltrated with 20 ml of 0.25% bupivacaine at incisional areas approximately 15 minutes before skin incision and 40 ml of intraperitoneal subdiaphragmatic 0.5% lidocaine was instillated at the end of laparoscopy. The control group received no treatment. When necessary, voltaren or petidine were administered IM after surgery. Postoperative pain was evaluated with the use of a visual analog scale (VAS) with scores ranging from 0-10 immediately after surgery and over the next 72 hours. The rate at which patients were discharged from the hospital 2-3 hours after surgery also recorded. Results: The treatment group had significantly lower pain scores both immediately after surgery and 12, 24 hours afterwards (P < 0.05). The time to first analgesia was longer in group A patients (p<0.002) .The need for postoperative analgesics also was significantly lower in the treatment group (p < 0.001). The rate at which patients were discharged 2-3 hours after surgery was significantly higher in the treatment group (p<0.001). Conclusion: Presurgical local infiltration of bupivacaine into the trocar insertion sites, and postoperative intraperitoneal subdiaphragmatic instillation of lidocaine of the trocar sites are useful methods for decreasing postoperative pain and analgesic consumption for up to 24 hours after laparoscopic gynecologic examination. In addition, the rate at which patients can be discharged from the hospital only 2-3 hours after surgery is increased significantly.