Intraperitoneal bupivacaine vs. tramadol for pain relief following day case laparoscopic surgery

Objectives To record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief. Design A prospective randomized study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used. Interventions Patients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2‐ml intravenous injection. Main outcome measures Each patient recorded the site of pain, and its severity using a 4‐point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same‐ or next‐day discharge was also assessed in all patients. Results The trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P < 0.05). Also, the time to first analgesia was prolonged and there was less need for fentanyl and earlier discharge in groups T and B. Conclusions We concluded that both of the analgesic regimens used were satisfactory, but intraperitoneal bupivacaine showed better analgesic outcomes and is a useful contribution to analgesia in the immediate postoperative period after day‐case laparoscopic surgery.