Analgesic efficacy of intraperitoneal local anaesthetic instillation (IPLA) in laparoscopic bariatric surgery: a systematic review and meta-analysis.

BACKGROUND

Laparoscopic bariatric surgery is effective for weight loss but often requires opioids for postoperative pain management, possibly increasing complications. Intraperitoneal local anaesthetic (IPLA) instillation may help to reduce pain and opioid use, though its efficacy remains unclear. This systematic review and meta-analysis aims to evaluate the impact of IPLA on postoperative pain management and opioid consumption in patients undergoing laparoscopic bariatric surgery.

METHODS

Following PRISMA guidelines, a systematic search of PubMed, Scopus, Web of Science and Cochrane Library (up to July 31, 2024) identified randomized controlled trials (RCTs) comparing IPLA with placebo or other analgesics. Primary outcomes were postoperative pain scores; secondary outcomes included opioid consumption, hospital length of stay (LOS) and incidence of postoperative nausea and vomiting (PONV). Risk of bias was assessed using Cochrane RoB2, and a random-effects model was used for statistical analysis.

RESULTS

Eight RCTs (n = 875) showed IPLA significantly reduced pain in the first 4 h (SMD: - 1.46, 95% CI: - 2.08 to - 0.85, p < 0.001) and 4-8 h postoperatively (SMD: - 1.16, 95% CI: - 1.94 to - 0.37, p < 0.001), with no effect beyond 8 h. IPLA reduced additional analgesic use (RR: 0.41, 95% CI: 0.25-0.66, p < 0.001) but without significant impact on LOS or PONV. Due to heterogeneity in opioid consumption reporting, a pooled analysis was not feasible.

CONCLUSION

IPLA effectively reduces early postoperative pain and opioid demand in laparoscopic bariatric surgery, though long-term benefits remain uncertain. Further high-quality RCTs are needed to establish optimal administration techniques and assess their broader clinical benefits.