Prophilaxis of postoperative pain by intraperitoneal instillation of trometanol-N after laparoscopic surgery- a comparative study with bupivacaine 0.5%

C. Mitre¹, I. Acalovschi¹, Viorica Butz², Corina Mâţu³
1. Catedra Anestezie Terapie Intensivă UMF „Iuliu Haţieganu” Cluj-Napoca
2. Medic rezident Anestezie Terapie Intensivă
3. Student UMF „Iuliu Haţieganu” Cluj-Napoca

Abstract

Background. The purpose of this randomized double blind and prospective study was to evaluate the postoperative analgesic efficacy of intraperitoneal instillated trometanol vs. 0.5% bupivacaine in patients submitted to laparoscopic cholecystectomy. The study was approved by our Ethics Committee, and all patients gave written informed consent.

Methods. Fifty-eight patients ASA I/II undergoing laparoscopic cholecystectomy, after intraperitoneal insuflation of CO2 received subdiaphragmatically 100 ml saline 0.9%, 100 mg (20 ml) 0.5% bupivacaine or 100 ml trometanol. All patients received a general anaesthesia with isoflurane. We evaluated the postoperative abdominal pain at rest and on movement, and the right shoulder pain, using a visual analog scale (VAS) at 1, 3, 6, 9, 12 and 24 hs after surgery, including the analgesic requirement. The postoperative respiratory function expressed as peak expiratory flow (PEF) at 6 and 12 hs postoperatively, and the incidence of vomiting, were also investigated. Results were analyzed using chi-square, Fisher’s test and Student’s t-test with statistical significance p < 0.05, and the confidence interval (CI) 95%. Data were expressed as mean ± SD.

Results. Intraperitoneal instillation of 100 mg trometanol compared to 100 mg bupivacaine 0.5% provided a significant reduction in the incidence and intensity of postoperative right shoulder pain with a very modest effect on the postoperative abdominal pain. The overall dose of analgetic (pethidine) used for postoperative analgesia was significantly reduced by the instillation of trometanol. The incidence of vomiting was influenced neither by trometanol nor by bupivacaine, but the administration of bupivacaine significantly reduced the PEF at 6 hours postoperativelly.

Conclusions. The results of this study indicate that intraoperative subdiaphragmatic administration of trometanol improved postoperative analgesia, reduced both right shoulder pain and postoperative opioid dose. In comparison with bupivacaine which produced a significant reduction of pulmonary function, instillation of trometanol did not influence respiratory function.

Key words: intraperitoneal bupivacaine and trometanol, laparoscopic cholecystectomy, post-operative analgesia

Profilaxia durerii postoperatorii cu trometanol-N intraperitoneal in colecistectomia laparoscopică. Studiu comparativ cu instilarea de soluţie de bupivacaină 0,5%

Jurnalul Român de Anestezie Terapie intensivă 2004 Vol.11 Nr.2, 92-98