A randomized controlled study of intraperitoneal vs intraincisional infiltration of local anesthetic levobupivacaine for pain relief in post-laparoscopic hysterectomy cases

Providing postoperative pain relief is a common acceptable practice in modern era. Multimodal combination methods are being used to reduce opioid-related side effects. We conducted a randomized study with 0.125% levobupivacaine in intraincisional infiltration vs intraperitoneal instillation for pain relief after laparoscopic hysterectomies.

In this randomized controlled study 90 patients of laparoscopic hysterectomy were selected. They were grouped as Group-C the control placebo, Group-I received local wound infiltration (intraincisional) of 20 ml solution of 0.125%, levobupivacaine while Group-P received 20 ml solution of 0.125%, levobupivacaine intraperitoneal space. Recording of post-surgical pain from 0 to 24 hours along with nausea and vomiting was done.

Post-operative pain was significantly lower and requirement butorphanol also less in intraincisional infiltration of 0.125% levobupivacaine in group-I (300±470μg)when compared to group-C and P (950±223, 600±502) in 1st 4 hours with significant p-value 0.000041 and in 24 hours group-C{783.33±415.45} group-I {466.67±503.09} and group-P {583.33±457.18} with significant p-value of 0.0013. Regarding opioid requirement in 1st-4 hours in group-C (90%) group-I only (30%) and group-P (60%), in 8–24 hours period in group-C (60%) compared to group-I(40%) and group-P(50%).

Incisional infiltration of levobupivacaine is more effective than intraperitoneal instillation in controlling the post-operative pain.