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      Intraperitoneal aerosolization of bupivacaine is a safe and effective method in controlling postoperative pain in laparoscopic Roux-en-Y gastric bypass

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          Abstract

          Introduction

          Obesity is a worldwide problem and has grown in severity in the last few decades making bariatric surgery and, in particular, laparoscopic banding and Roux-en-Y gastric bypass efficacious and cost-effective procedures. The laparoscopic approach has been shown to offer significant healthcare benefits, of particular interests are reports of decreased postoperative pain resulting in a shorter hospital stay and an earlier return to normal activity. However, many patients still experience significant pain, including shoulder tip pain, that require strong analgesia including opiates during their early recovery period. The aims of this study were to establish the safe use of the aerosolization technique in bariatric surgery and to investigate the possible benefits in reducing postoperative pain.

          Methods

          In this study, fifty patients undergoing laparoscopic gastric bypass were recruited and divided into two groups; control (n = 25) and therapeutic (n = 25). The control group received intraperitoneal aerosolization of 10 mL of 0.9% normal saline while the therapeutic group received 10 mL of 0.5% bupivacaine. All the patients had standard preoperative, intraoperative, and postoperative care. Pain scores were carried out by the nursing staff in recovery and 6 h, 12 h and 24 h postoperatively using a standard 0–10 pain scoring scale. In addition, opiate consumption via patient-controlled analgesia (PCA) was recorded.

          Results

          Aerosolized bupivacaine reduced postoperative pain in comparison to normal saline (p < 0.05). However, PCA usage showed no statistically significant change from the control group.

          Conclusion

          The aims of this study were achieved and we were able to establish the safe use of the aerosolization technique in bariatric surgery and its benefits in reducing postoperative pain.

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          Most cited references 11

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          Paid work increases and state benefit claims decrease after bariatric surgery.

          Bariatric surgery is a clinically effective treatment for obesity and has been shown to be cost-effective. The impact of bariatric surgery on the subsequent ability to work and the uptake of state-funded benefits is not well documented. A consecutive series of 79 patients who had undergone laparoscopic Roux-en-Y gastric bypass (LRYGBP) or laparoscopic adjustable gastric banding (LAGB) were surveyed to assess changes in their ability to work and the number and type of state benefits claimed after surgery. 59 patients (75%) responded, median age 45, median follow-up 14 months. There was a 32% increase in the number of respondents in paid work after surgery (P<0.05). The mean weekly hours worked increased from 30.1 to 35.8 hours (P<0.01). Respondents also reported a decrease in obesity-related physical and emotional constraints on their ability to do work (P<0.01). Fewer patients claimed state benefits postoperatively (P<0.01). More patients perform paid work after LRYGBP and LAGB than beforehand, and the number of weekly hours they work increases. After surgery, patients claim fewer state benefits.
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            Preemptive port site local anesthesia in gynecologic laparoscopy: a randomized, controlled trial.

            To assess the impact of preemptive infiltration of port site with local anesthetic on postlaparoscopy pain.
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              Randomized trial of periportal peritoneal bupivacaine for pain relief after laparoscopic cholecystectomy.

               S S Ngoi,  L. Lee,  P. Goh (1996)
              The aim of this study was to determine whether injection of a long-acting local anaesthetic, in relation to the port sites at the level of the parietal peritoneum, would reduce postoperative pain following laparoscopic cholecystectomy. Patients were entered into a randomized, prospective, double-blind study comparing the effects of a standard technique, in which bupivacaine (total of 20 ml, 0.5 per cent) was injected into the subcutaneous periportal tissue around the four port sites, and a technique in which bupivacaine (total of 20 ml, 0.25 per cent) was injected into the subcutaneous periportal tissue as above with the addition of periportal parietal peritoneal injection of bupivacaine (total of 20 ml, 0.25 per cent). Two scores for pain, with the patient at rest, and on movement, were assessed 6 and 18 h after surgery using a visual analogue pain scale. Median pain score was significantly higher in patients who received standard technique (n = 40) than in those given peritoneal injection (n = 40) at both 6 (rest = 3.0 versus 1.0, movement = 5.0 versus 2.9) and 18 h (rest = 1.9 versus 0, movement = 3.2 versus 1.2). Both opiate and oral analgesic requirements were reduced in patients administered peritoneal injection, although this was not statistically significant. The addition of periportal injection of bupivacaine at the level of the parietal peritoneum, performed under direct vision, reduces pain after laparoscopic cholecystectomy.
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                Author and article information

                Journal
                J Pain Res
                Journal of Pain Research
                Journal of pain research
                Dove Medical Press
                1178-7090
                2008
                1 December 2008
                : 1
                : 9-13
                Affiliations
                [1 ] Department of Biosurgery and Technology, Imperial College London, UK
                [2 ] Department of Surgery, Alexian Brothers Hospital Network, Chicago, USA
                Author notes
                Correspondence: Nawar A Alkhamesi, Department of Biosurgery and Technology, Imperial College London, 10th Floor, QEQM Wing, St. Mary’s Hospital, Praed Street, London W2 1NY, UK, Tel +44 20 7886 6119, Fax +44 20 7886 1810, Email n.alkhamesi@ 123456imperial.ac.uk
                Article
                jpr-1-009
                3004614
                21197283
                © 2008 Alkhamesi et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                Categories
                Original Research

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