Annals of Coloproctology

Original Article

Postoperative Pain Relief Using Wound Infiltration With 0.5% Bupivacaine in Single-Incision Laparoscopic Surgery for an Appendectomy: So Ra Ahn, Dong Baek Kang, Cheol Lee, Won Cheol Park, Jeong Kyun Lee; Ann Coloproctol. 2013;29(6):238-242. Published online December 31, 2013; DOI: https://doi.org/10.3393/ac.2013.29.6.238

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Purpose

Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A.

Methods

Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS).

Results

Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group.

Conclusion

W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.

Citations

Citations to this article as recorded by

Transversus abdominis plane block for laparoscopic cholecystectomy in short-term acute care hospital
V.V. Bedin, V.Yu. Vengerov, O.V. Makarov, N.I. Koroleva, K.A. Loginov, V.L. Polianskii, F.G. Pilyus
Pirogov Russian Journal of Surgery.2024; (12): 13. CrossRef
Clinical Outcomes of Single-incision Laparoscopic Appendectomy Versus Conventional Laparoscopic Appendectomy in Adult Acute Appendicitis
SHINTARO KOHAMA, KUNIHIKO NAGAKARI, MASAKAZU OHUCHI, KAZUHIRO TAKEHARA, KUMPEI HONJO, SHUN ISHIYAMA, KIICHI SUGIMOTO, SHINICHI OKA, JIRO YOSHIMOTO, MASAKI FUKUNAGA, YOICHI ISHIZAKI, KAZUHIRO SAKAMOTO
Juntendo Medical Journal.2024; 70(6): 436. CrossRef
Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review
Dusica M. Stamenkovic, Mihailo Bezmarevic, Suzana Bojic, Dragana Unic-Stojanovic, Dejan Stojkovic, Damjan Z. Slavkovic, Vladimir Bancevic, Nebojsa Maric, Menelaos Karanikolas
Journal of Clinical Medicine.2021; 10(20): 4659. CrossRef
Determination of the efficacy of ultrasound-guided bilateral transversus abdominis plane (US-TAP) block in laparoscopic total extraperitoneal (TEP) repair of unilateral hernia surgeries: A randomized controlled trial
Vijayalakshmi Sivapurapu, SriVengadesh Gopal, Ashley Solomon
Journal of Anaesthesiology Clinical Pharmacology.2021; 37(3): 475. CrossRef
Effect of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy: double-blind randomized study
Heon-Kyun Ha, Kyung-Goo Lee, Kang Kook Choi, Wan Sung Kim, Hyung Rae Cho
Annals of Surgical Treatment and Research.2020; 98(2): 96. CrossRef
Unilateral transversus abdominis plane block and port-site infiltration
Emine Arık, T. Akkaya, S. Ozciftci, A. Alptekin, Ş. Balas
Der Anaesthesist.2020; 69(4): 270. CrossRef
Effect of Local Anesthesia on the Postoperative Pain After Laparoscopic Appendectomy
Samir Čustovic, Haris Pandža, Samir Delibegovic
Journal of Laparoendoscopic & Advanced Surgical Techniques.2019; 29(1): 65. CrossRef
Diagnosis and management of acute appendicitis. EAES consensus development conference 2015
Ramon R. Gorter, Hasan H. Eker, Marguerite A. W. Gorter-Stam, Gabor S. A. Abis, Amish Acharya, Marjolein Ankersmit, Stavros A. Antoniou, Simone Arolfo, Benjamin Babic, Luigi Boni, Marlieke Bruntink, Dieuwertje A. van Dam, Barbara Defoort, Charlotte L. Dei
Surgical Endoscopy.2016; 30(11): 4668. CrossRef
Is transverse abdominis plane block effective following local anesthetic infiltration in laparoscopic totally extraperitoneal hernia repair?
Mun Gyu Kim, Soon Im Kim, Si Young Ok, Sang Ho Kim, Se-Jin Lee, Sun Young Park, Jae-Hwa Yoo, Ana Cho, Kyung Yul Hur, Myung Jin Kim
Korean Journal of Anesthesiology.2014; 67(6): 398. CrossRef
Preemptive Analgesia in Single-Incision Laparoscopic Surgery
Eui Gon Youk
Annals of Coloproctology.2013; 29(6): 221. CrossRef

Randomized Controlled Trials

The Effects of Pudendal Block in Voiding Complication after Anal Surgery.: Kim, Jae Hwang , Jang, Seon Mo , Shim, Min Chul , Jee, Dae lim; J Korean Soc Coloproctol. 2000;16(6):365-370.

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Abstract PDF: Urinary retention in common benign anal surgery is a burden to ambulatory surgery. PURPOSE: To reduce voiding complication pudendal nerve block (PB) was applied in hemorrhoids surgery.
METHODS
We compared PB with spinal anesthesia (SA) for anal surgery. In this prospective study, 163 patients undergoing elective hemorrhoids surgery by single surgeon were randomized to receive either PB with 0.5% bupivacaine (n=81) with 1: 20,000 epinephrine or SA with 0.5% bupivacaine (n=83).
RESULTS
There were no statistically significant differences in patient demographics, total amount of administered fluid, time to onset of block, or intraoperative pain. All patients had a successful block for surgery however, puborectalis muscle relaxation with PB was not complete. The time from injection of the anesthetics to first development of pain was longer in the patients who received PB (9.1 vs 3.1h; P<0.001). Urinary catheterization needed in only 6 patients in PB group compared with 57 cases in SA group (p<0.001). Degree of pain was significantly low in PB (2.7 vs 5.2 with VAS; p<0.001) Injected analgesics was significantly reduced in PB (16/81 vs 45/82; p<0.001) CONCLUSIONS: Our results suggest that PB with bupivacaine results in fewer postoperative voiding complications and less pain compared with traditional SA in hemorrhoidectomy.

Comparison of Mepivacaine and Bupivacaine as an Adjuvant of Morphine for Benign Anorectal Surgery under Caudal Anesthesia.: Yun, Sung Mun , Park, Ki Hong , Lim, Jun Sang , Kim, Sung Chul; J Korean Soc Coloproctol. 1998;14(3):517-522.

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Abstract PDF: BACKGROUND
/AIMS: The caudal anesthsia is most commonly used for benign anorectal surgery, The combination of long-acting anesthetics and opiates has been used for longer duration and successful control of postoperative pain. But the side effects of peridural anesthesics and morphine have commonly occured in caudal anesthesia. This study was performed to assess the difference in clinical effects between peridural mepivacaine and bupivacaine with morphine.
METHODS
We evaluated the clinical effects in 60 patients who had anal operation with Jack-Knife position under caudal anesthesia. We divided randomly these 60 patients into two groups, M and B groups (in each group, 30 patients included). Group M (n=30) was given 2% mepivacaine 20 ml with morphine 2 mg caudally, and Group B (n=30) was given 0.5% bupivacaine 20 ml with morphine 2 mg in the same manner. We measured the onset time, duration, postoperative analgesia, and side effects including urinary retention.
RESULTS
The onset time for analgesia was significantly shorter in group M than in group B. The duration of postoperative pain complaints was significantly longer in group M than in group B. The postoperative analgesic effects and side effects were not significantly different between two groups.
CONCLUSIONS
Caudal mepivacaine and morphine mixture is effective for control of postoperative pain without significant side effects.

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