ABSTRACT

The study investigates the effect of transcervical intraperitoneal analgesia with meperidine versus bupivacaine, or combination of both after gynecological laparoscopic ovarian cystectomy.

Sixty patients were enrolled in a randomized double blind study. All patients underwent laparoscopic ovarian cystectomy. Patients were classified into four equal groups, group Meperidine: received intraperitoneal (IP) meperidine 100 mg and IM saline, group Bupivacaine: received IP local anesthetic bupivacaine (10ml saline + 10ml bupivacaine 0.5%) and IM saline, group Bupivacaine+: received IP combination of meperidine 100 mg and bupivacaine (0.25% after dilution in the 20ml syringe) and IM saline, and Control Group: received IP saline and IM meperidine 100 mg. Postoperative pain was assessed both at rest and on movement at arousal, 2, 4, 6, 12, and 24 hours postoperatively. The patients were asked to rate the severity of pain via a visual analog scale (VAS). If the VAS was greater than 3, 2mg morphine was administered IV and could be repeated on demand and the total dose of postoperative morphine were recorded for 24 h. Throughout the postoperative observational period, the pain scores were significantly less in group bupivacaine+ ( P <0.01) than in other goups. The greatest difference was seen at 2, 4 hr (P <0.001) in the pain scores measured at rest and on movement, and the least differences between the four groups was observed at arousal (20-30 min) and at 24 h both at rest and on movement (P <0.05). The total dose of IV morphine used over 24 hr was lower in group bupivacaine+ 4mg used by 2 patients and the highest dose used in group control (22mg). Most of opioid used between 2, and 4 hrs postoperative period. The percentage of patients satisfactions was higher in group bupivacaine+ and lowest in control group during 24 hr observation in the PACU. IP administration of meperidine combined with bupivacaine provides better postoperative analgesia. Moreover this combination lowers opioid consumption, without side effects, and better patient satisfaction than each one alone after gynecological laparoscopic ovarian syctectomy.