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Intraperitoneal local anaesthetic in abdominal surgery – a systematic review

Authors


  • Funding: Arman Kahokehr is recipient of the Ruth Spencer fellowship from the Auckland Medical Research Foundation. Tarik Sammour is recipient of a Surgeon Scientist scholarship from the Royal Australasian College of Surgeons.

  • This work was presented at the Association of Academic Surgeons Annual Scientific Congress in San Antonio, Texas, February 3, 2010. This research was conducted during tenure of the Ruth Spencer fellowship from the Auckland Medical Research Foundation held by Arman Kahokehr and the Surgeon Scientist Scholarship from the Royal Australasian College of Surgeon held by Tarik Sammour.

  • A. Kahokehr BHB, MBChB; T. Sammour BHB, MBChB; M. Soop PhD, FRACS; A. G Hill MD, FRACS, FACS.

Dr Arman A Kahokehr, Department of Surgery, South Auckland Clinical School, Private Bag 93311, Middlemore Hospital, Otahuhu, Auckland 1649, New Zealand.
Email: arman.kahokehr@middlemore.co.nz; arman.kahokehr@gmail.com

Abstract

Background:  The use of intraperitoneal local anaesthetic (IPLA) can be used to modulate visceral nociception after abdominal surgery; however, this technique is not routinely used in open abdominal surgery. The aim of this systematic review was to appraise the clinical effects of IPLA in open abdominal surgery for metachronous outcomes including pain, metabolic response to surgery and gastrointestinal function.

Methods:  A comprehensive search was conducted independently without language restriction. Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Post-operative clinical and metabolic outcomes of randomized controlled trials comparing IPLA versus no IPLA or placebo solution were used for meta-analysis.

Results:  Twelve trials were identified including eight randomized trials in gastrointestinal and gynaecological surgery. Post-operative pain was reduced but not opioid use. There was blunting of postoperative hyperglycaemia. There was no difference in post-operative cortisol response. Return of bowel function appeared to be quickened, although meta-analysis was not possible.

Conclusion:  The use of IPLA is safe and appears to have clinical benefits. However this technique has not been studied in optimized perioperative settings. Trials are needed to evaluate this method of visceral blockade further after major abdominal surgery.

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