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 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 __ 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) 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 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 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 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 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 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 __ 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) 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 __ 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