Comparison of Bupivacaine Trocar Site Infiltration and Peritoneal Instillation for Postoperative Pain in Pediatric Laparoscopic Surgery

TL;DR

This study compares two methods of using bupivacaine to reduce postoperative pain in children after laparoscopic surgery and finds one method more effective.

Contribution

The study provides new evidence that intraperitoneal bupivacaine is more effective than trocar site infiltration for postoperative pain in pediatric laparoscopic surgery.

Findings

Intraperitoneal bupivacaine resulted in significantly lower mean pain scores compared to trocar site infiltration.

The P group had significantly less need for rescue analgesia and lower incidence of shoulder pain.

The study supports adopting intraperitoneal instillation to improve postoperative outcomes in pediatric laparoscopic surgery.

Abstract

Background

Laparoscopic surgery has become the treatment of choice for pediatric patients due to its numerous advantages over open surgery. However, postoperative pain remains a significant barrier to rapid recovery. The intraperitoneal use of local anesthetics for pain management is underutilized in the pediatric population. This study aimed to compare the effectiveness of bupivacaine administered at the trocar site versus in the peritoneal cavity for managing postoperative pain in pediatric laparoscopic surgery.

Methodology

This quasi-experimental study was conducted in the Department of Pediatric Surgery at the Combined Military Hospital, Lahore. A total of 80 patients who underwent laparoscopic surgery were divided into two groups of 40 each. The W Group received bupivacaine trocar site infiltration, while the P Group received intraperitoneal bupivacaine instillation at the end of surgery. Pain scores were recorded in both groups at one, two, four, six, and eight hours postoperatively. The need for rescue analgesia and the incidence of shoulder pain were also evaluated as secondary outcomes in both groups.

Results

The mean pain score was 19.15 ± 3.8 in the W group, compared to 17.30 ± 4.0 in the P group, with a calculated p-value of 0.03, indicating a significant difference between the two groups. Similarly, interval pain scores, the need for rescue analgesia, and the incidence of shoulder pain were significantly lower in the P group compared to the W group.

Conclusion

We concluded that intraperitoneal instillation of bupivacaine is more effective than trocar site infiltration with the same agent in reducing postoperative pain across various pediatric laparoscopic procedures. This approach should be adopted to maximize the benefits of minimally invasive surgery in the pediatric population.

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