Table 2a

Table 2a. Local anaesthetic (LA) wound infiltration versus placebo or no treatment: Study details and qualitative outcomes

Study

n treatment/control

Comparison

Supplemental analgesia

VAS Scores and type of pain, where specified

Time to first analgesic request

Use of supplemental analgesic

Other important outcomes

Alexander 1996

(LoE 1)

40/40

At the time of induction: 20 ml bupivacaine (0.25%) injected around the four port entry sites at the level of the parietal peritoneum and 20 ml bupivacaine (0.25%) in the subcutaneous tissue around the four ports (Bup) vs. 20 ml bupivacaine (0.5%) in the subcutaneous tissue around the four ports (Cont)

Postop: oral naproxen (2 x 550 mg tablets) and/or IM pethidine (50 mg), as required

Bup superior at 6 h at rest (p<0.01) and on movement (p<0.05) and at 18 h at rest and on movement (p<0.01)

__

Pethidine and naproxen (mg/ patient): NS

__

Dath 1999

(LoE 2)

50/47

 

Before closure: infiltration of 20 ml 100 mg bupivacaine (0.5%) with epinephrine (Bup+Ep) vs. no instillation of bupivacaine (Cont)

Postop: morphine (2–4 mg) on demand in PACU; IM mepiridine or acetaminophen with codeine (30 mg) at 4 h intervals, as requested

Bup+Ep superior at <2 h (p<0.001) and 6 h (p<0.025); NS at 10 h and next morning

__

NS in PACU and short-stay unit

Hospital Discharge

Rate of same-day discharge: Bup+Ep superior (p=0.034)

Lee 2001

(LoE 1)

22/21/25

Pre-op peri-portal bupivacaine (PreBup) vs. postop peri-portal bupivacaine (PostBup) vs. no treatment (NT)

Postop: IM ketorolac (30 mg), every 8 h for 48 h + additional 30 mg IV, if requested; IM demerol (25 mg), if needed

Incisional pain: both PreBup and PostBup superior to NT (p<0.05) at 1 and 2 h; PreBup superior to NT at 3 h (p<0.05); intra-abdominal pain: NS at all times (i.e. at 1, 2, 3, 6, 9, 12, 24, 36 and 48 h)

__

Ketorolac requirements for 48 h: PreBup superior to NT (p<0.05)

Pain

Shoulder pain, epigastric pain, right flank pain and back pain: NS

PONV

Nausea and vomiting: NS, but highest incidence in NT group

Lepner 2003

(LoE 1)

20/20

Before wound closure, infiltration with 80 ml bupivacaine (0.125%) + phenylephrine (5 mg) (Bup) vs. infiltration with saline (Cont)

Postop: IM diclofenac (75 mg twice/day on 1st day) and then oral (100 mg twice/day for next 2 days) and IV/IM pethidine, on request

Bup superior at 3–24 h (p<0.007)

__

Number patients requiring pethidine: Bup superior (p<0.05)

PONV

Nausea and vomiting: NS

Hospital Stay

Length of hospital stay: NS

Papagiannopoulou 2003

(LoE 1)

20/19/18

Pre-incisional local infiltration with 20 ml ropivacaine (1%) (Rop) vs. 20 ml levobupivacaine (0.5%) (Levobup) vs. 0.9% saline solution (Cont)

Postop: patients with VAS scores > 3 given diclofenac 50–100 mg rectally; patients with persistent pain given parenteral opioids (e.g. dextropro-poxyphene)

Rop superior to Cont at 2 and 4 h (p<0.001) but not 24 h

Levobup superior to Cont at 2, 4 and 24 h (i.e. at all times) (p<0.001) and superior to Rop at 4 and 24 h (p<0.001) but NS at 2 h

__

Diclofenac and propoxyphene consumption: both Rop and Levobup superior to Cont (p<0.001); Rop also superior to Levobup for diclofenac consumption (p<0.001), but not for propoxyphene consumption

PONV

Nausea and vomiting: recorded, but data not given

Papaziogas 2001

(LoE 1)

17/18

Pre-incisional IV saline plus local infiltration with 20 ml ropivacaine (10 mg/ml) (Rop) vs. pre-incisional placebos (Pb)

Postop: diclofenac rectally (50–100 mg) or parenteral dextropro-poxyphene (75 mg), if required; IM pethidine (50 mg) if dextropro-poxyphene not sufficient

Rop superior at 0, 3, 6, 12 and 24 h(p<0.05), but NS at 48 h

Rop superior (p<0.05)

Rop superior (p<0.05) for all types of analgesics

PONV

Nausea and vomiting: NS

Pavlidis 2003

(LoE 1)

75/75

Pre-incisional local infiltration of port sites with 20 ml ropivacaine containing 1 mg/ml (Rop) vs. 20 ml saline (Cont)

Postop: IM diclofenac (75 mg) (if VAS >3); IM dextropro-poxyphene and pethidine if required

Rop superior at 3 and 6 h (p<0.01), but NS at 12 and 24 h

__

Opioid requirements (pethidine): Rop superior (p<0.05)

Pain

Shoulder pain: NS

PONV

Nausea and vomiting: NS

Hospital Stay

Length of hospital stay: NS

Sarac 1996

(LoE 2)

20/25/25

Pre-incisional bupivacaine (0.25%) (preBup) vs. post-procedure bupivacaine (0.25%) (postBup) vs. 0.9% saline injected SC (Cont)

Solutions injected into each trocar site

Postop: IM pethidine (1 mg/kg) if VAS > 5; parenteral pethidine IM in recovery room if required

PostBup only superior to Cont for the 1st hour only (p<0.01); other timings (i.e. 3, 5, 7 and 12 h): NS

__

Parenteral pethidine requirement: both PreBup and PostBup superior to Cont in the 1st hour only (p<0.05); total analgesic requirement: higher in Cont group, but NS

__

Ure 1993

(LoE 1)

25/25

Pre-incisional infiltration with 32 ml bupivacaine (0.5%) (Bup) vs. 32 ml saline (Cont)

Postop: PCA IV piritramide for 24 h postop; oral ibuprofen (500 mg) after 24 h, if required

Intensity of pain (at rest, on movement, coughing): NS (recorded at 5 h, at 8 a.m. and 6 p.m. on day 1 and at 8 a.m. on the following days, up to discharge)

__

Piritramid use: NS; total ibuprofen consumption: Bup superior, but NS

Pain

Number of patients with most severe pain located to the right lower abdominal wall on day 2: Bup superior (p=0.012); number of patients with no pain after 5 h: Bup superior (p=0.03)

Uzunköy 2001

(LoE 1)

15/15/15

Pre-incisional bupivacaine (0.25%) (preBup) vs. post-procedure bupivacaine (0.25%) (postBup) vs. no LA (Cont) at trocar sites

Postop: diclofenac sodium (75 mg), as required

Both PreBup and PostBup superior to Cont (p<0.05); NS for PreBup vs. PostBup comparison; pain VAS were recorded at 1, 4, 12 and 24 h, but specific times not stated for results – unclear if pain scores have been averaged over the 24 h period)

__

NS

__

Zajaczkowska 2004

(LoE 1)

30/30/30

Preop local infiltration at trocar insertion points with: 20 ml bupivacaine (0.25%) (Bup) vs. saline (Cont)

Postop: IV tramadol (100 mg), on request

NS (recorded at 4, 8 and 12 h)

Bup superior (p<0.05)

NS

PONV

Nausea and vomiting: NS