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Does Preincisional Infiltration with Bupivacaine Reduce Postoperative Pain in Laparoscopic Bariatric Surgery?

Moncada R (1,2), Martinaitis L (3), Landecho M [ES] (4,5), Rotellar F (6,7), Sanchez-Justicia C (8), Bellver M (9), de la Higuera M [ES] (10), Silva C [ES] (11), Osés B (12), Martín E (13), Pérez S (14), Hernandez-Lizoain JL (15), Frühbeck G (16,17,18,19), Valentí V (20,21,22,23). (1) Department of Anesthesiology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(2) Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
(3) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(4) Internal Medicine, Clínica Universidad de Navarra, Pamplona, Spain.
(5) TRUEHF, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
(6) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(7) CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
(8) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(9) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(10) Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(11) Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(12) Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(13) Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(14) Clinical Nurse Inpatient General Surgery, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(15) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(16) CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
(17) Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(18) Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
(19) Department of Endocrinology, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(20) Department of Surgery, Bariatric and Metabolic Surgery, Clínica Universidad de Navarra, Avenida Pío XII, 36, 31008, Pamplona, Navarra, Spain.
(21) CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Pamplona, Navarra, Spain.
(22) Metabolic Research Laboratory, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
(23) Obesity and Adipobiology Group, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.

Revisão:Obesity Surgery

Data: 1/Fev/2016

Cirurgia Geral e Digestiva Endocrinologia e Nutrição [ES] Área de Obesidade Medicina Interna [ES]

BACKGROUND:

Current evidence suggests that local anesthetic wound infiltration should be employed as part of multimodal postoperative pain management. There is scarce data concerning the benefits of this anesthetic modality in laparoscopic weight loss surgery. Therefore, we analyzed the influence of trocar site infiltration with bupivacaine on the management of postoperative pain in laparoscopic bariatric surgery.

METHODS:

This retrospective randomized study included 47 patients undergoing primary obesity surgery between January and September 2014. Laparoscopic gastric bypass was performed in 39 cases and sleeve gastrectomy in 8 cases. Patients were stratified into two groups depending on whether preincisional infiltration with bupivacaine and epinephrine was performed (study group, 27 patients) or not (control group, 20 patients). Visual analogue scale (VAS), International Pain Outcomes questionnaire, and rescue medication records were reviewed to assess postoperative pain.

RESULTS:

VAS scores in the study group and sleeve gastrectomy group were lower than those in the control and gastric bypass groups in the first 4 h postoperatively without reaching statistical significance (p > 0.05). VAS scores did not differ in any other period of time. No statistically significant differences in pain perception were registered according to the patient's pain outcomes questionnaire or the need for rescue medication.

CONCLUSIONS:

The present study did not conclusively prove the efficacy of bupivacaine infiltration by any of the three evaluation methods analyzed. Nevertheless, preincisional infiltration provides good level of comfort in the immediate postoperative period when analgesia is most urgent.

CITAÇÃO DO ARTIGO  Obes Surg. 2016 Feb;26(2):282-8. doi: 10.1007/s11695-015-1761-0.

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