Aim: To assess the effectiveness of combined preincisional local infiltration (at trocar sites) and intraperitoneal instillation of levobupivacaine 0.25% for the management of early postoperative pain following laparoscopic ovarian drilling.
Materials and Methods: This is a prospective randomized controlled observer-blinded study. The study included 106 infertile patients with the diagnosis of polycystic ovary syndrome (PCOS) who were scheduled to undergo diagnostic laparoscopy and laparoscopic ovarian drilling (LOD) during the period from November 2009 to February 2012 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 53 patients each. Group I comprised patients who received preincisional local infiltration and intraperitoneal instillation levobupivacaine 0.25%. Patients in group II received equal volumes of normal saline 0.9% (NS) at the same sites. The primary outcome measures were visual analog scale pain scores and postoperative analgesic consumption.
Results: Postoperative average VAS pain scores, i.m. pethidine consumption and i.v. paracetamol consumption during the first 24 h were highly significantly lower in the levobupivacaine group compared to the NS group (P < 0.01). This technique was also associated with significantly higher overall patient satisfaction, shorter hospital stay and more rapid resumption of normal activity (P < 0.01) without any significant adverse events.
Conclusion: The combination of preincisional local infiltration and intraperitoneal instillation of levobupivacaine 0.25% was found to substantially reduce postoperative pain and the consumption of postoperative analgesics during the first 24 h; and shorten hospital stay and time to resume normal activities after LOD. It was also associated with a very high overall patient satisfaction without any significant adverse events.