Effect of local anesthetics on postoperative pain and opioid consumption in laparoscopic colorectal surgery.

BACKGROUND: Several studies have evaluated use of local anesthetic, specifically, administration of intraperitoneal anesthetic, during laparoscopic general surgery and gynecologic operations, with varying results. There have been no studies to determine the role of local anesthetic in laparoscopic colorectal surgery. This study evaluates the efficacy of subcutaneous and intraperitoneal anesthetic in reducing postoperative pain following common laparoscopic colorectal procedures, in patients managed with enhanced recovery care pathways.

METHODS: A single-institution retrospective cohort analysis of 172 patients who underwent common elective laparoscopic colorectal procedures was carried out. Over three consecutive time periods, patients were divided into three study arms, based on administration of local anesthetic. The first group received no local anesthetic (n = 66), the next received only subcutaneous bupivacaine (n = 67), and the final group received both subcutaneous bupivacaine and intraperitoneal lidocaine (n = 44). Pain scores, time in the postoperative care unit, and the amount of opioid pain medication consumed in the immediate postoperative period were quantified.

RESULTS: There was no difference in pain scores reported between the three study arms, including upon arrival and upon leaving the recovery unit (P ≤ 0.086, P ≤ 0.166), and at 3, 6, 9, and 12 h postoperatively (P ≤ 0.332, P ≤ 0.142, P ≤ 0.155, P ≤ 0.872). There was no significant difference in the amount of postoperative opioid analgesia consumed between the three study arms on postoperative day 0 and on postoperative day 1 (P ≤ 0.365, P ≤ 0.458). There were no significant differences in the amount of time spent in the postoperative care unit, hospital stay, 30 day morbidity, or 30 day mortality between the three study arms.

CONCLUSIONS: Use of local anesthetic does not influence postoperative opioid requirements or patients' subjective report of pain following laparoscopic colorectal procedures managed within enhanced recovery care pathways.